부산대학교 도서관

Introduction:Severe cardiopulmonary failure, in the peripartum period, is rare but potentially fatal. The use of Mechanical Circulatory Support (MCS) in this setting has been scarcely described and long-term outcomes remain unclear. Therefore, we sought to evaluate short and long-term outcomes with the use of MCS to support patients in severe cardiopulmonary failure in the peripartum period at our large academic institution.Methods:Retrospective review of females with peripartum cardiopulmonary failure who underwent MCS placement between April 2009 and September 2018. Survival curve was estimated using Kaplan-Meyer method.Results:During the study period, 17 female patients required MCS placement in the peripartum period. Mean age was 27 ? 6.2 years. Four patients developed peripartum ARDS and underwent VV-ECMO placement. Thirteen patients developed severe refractory cardiogenic shock (CS). Of these, 9 underwent VA-ECMO placement, 2 underwent heart transplant (Htx) and 2 underwent LVAD placement (1 successfully explanted). Four patients had concomitant IABP use. Of the 9 VA-ECMO patients, 4 were bridged to recovery (2 of them were transitioned to VV-ECMO before decannulation), 4 were bridged to durable LVAD (2 successfully explanted and 1 bridged to Htx) and 1 was bridged directly to Htx. Average duration of ECMO support, ICU-stay and hospital stay was 10?8 days, 26?23 days and 41?28 days, respectively. Overall survival to hospital discharge was 88% (15/17) (ARDS: 100%, CS: 85%). In the CS cohort survival at 1 and 5-year was 85% and 75%, respectively (figure 1).Conclusions:The use of MCS in the peripartum period is associated with excellent short and long-term outcomes. VA-ECMO offers a stable platform for bridge to recovery, bridge to Htx/VAD or bridge to bridge strategies. Future clinical and mechanistic studies are required to understand the durability of the different strategies which may obtain in the recovery of these critically ill young women.