Reports Cardiac Surgery

ECMO and cytokine removal for bridging to surgery in a patient with ischemic ventricular septal defect – a case report

Marek S, Gamper G, Reining G, Bergmann P, Mayr H, Kliegel A.
Int J Artif Organs 2017; pub

Post-infarction ventricular septal defect (VSD) remains a serious and often lethal complication of percutaneous coronary...

Post-infarction ventricular septal defect (VSD) remains a serious and often lethal complication of percutaneous coronary intervention.  It remains unclear whether surgery to correct this should be done immediately or delayed until after the patient is stabilized. This is a case report on the use of veno-arterial extracorporeal membrane oxygenation (ECMO) and extracorporeal blood purification therapy (CytoSorb®) in a 64-year-old patient with ischemic VSD leading to protracted cardiogenic shock and hemodynamic instability requiring large doses of catecholamines after a myocardial infarction. After a few hours with ECMO and CytoSorb the patient began to stabilize hemodynamically.  The catecholamines (norepinephrine, dobutamine) and vasopressin could be significantly reduced (or stopped in the case of vasopressin) within the first 36 hours of treatment. After 4 days of treatment with ECMO and CytoSorb® therapy the patient was stable enough to be taken to surgery, where repair of the VSD and bypass grafting was successfully performed.