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Abstract

End-stage pulmonary hypertension alters intracardiac pressures, leading to distention and failure of the right ventricle, leftward shifting of the intraventricular septum, and, thus, underfilling of the left ventricle (LV). Following the resolution of severely elevated pulmonary vascular resistance with bilateral lung transplantation, the LV is exposed to relatively high filling pressures from a potentially hypertrophic right ventricle pushing blood through normalized pulmonary vascular resistance. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) may be a valuable tool to provide a more gradual exposure of the LV to the newly available preload in the immediate postoperative phase of transplantation, thereby reducing the likelihood of primary graft dysfunction developing from the LV diastolic dysfunction. This paper presents a case in which V-A ECMO was initiated during cardiac arrest in a patient with advanced pulmonary hypertension and right ventricular failure and maintained for two days for postoperative patient stability and cardiac conditioning. The discussion includes data from transplant programs using this method to reduce the need for dual organ transplantation and postoperative primary graft dysfunction in the allograft.

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