1. ECMO and MCS in Naples
Dr. Cristiano Amarelli
Perfusionist: Emanuele Petrazzuolo
Department of Cardiothoracic Surgery and Transplants
Second University of Naples
Monaldi Hospital
Napoli

2. Heart Transplantation 1988-2010
558 transplants on 553 patients (12 pediatrics)
40 38 39
37 36
35 34
32 32 32
28 30 28
30 27 28
25 24
20 22
20
18
15
10 12
8
10 8 9
6
5
0
'88
'89
'90
'91
'92
'93
'94
'95
'96
'97
'98
'99
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010

3. Centro Nazionale Trapianti
*Dati definitivi al Agosto 2010
Trapianti di CUORE – Anni 1992/2010*
Inclusi i trapianti
combinati
32
28 36 39 32
38 24
27 22 29
28 37 32 30
20 34
18
9
12
390 369
348 337 337 353 344345 326
302 298 316 312 317 311 354
243 229
255
*
92
94
96
98
00
02
04
06
10
08
19
19
19
19
20
20
20
20
20
20 FONTE DATI: Dati Reports CIR

4. MCS 2007-2010
22 MCS on 15 patients
8
4+3
Oxygenator
7

11. Experience in Naples with ventricular assistances
19952007 9 Novacor
2007
1 ABIOMED died for infection before heart transplantation Intermacs 3
1 ABIOMED crash and burn
2008
1 De Bakey crash and burn
2009 4 LEVITRONIX
V. M. RVAD (Levitronix) + LVAS (Heartmate) Intermacs 2 OK
S. G. RVAD (Levitronix post Redo for Prosthetic Endocarditis) crash and burn OK
S. A. ECMO per IR after Emergent Mitral Rupture crash and burn
S. D. LVAS (Heartmate)  RVAD (Levitronix) and upgrade to V-V ECMO (Levitronix)
2010 5 LEVITRONIX + 3 ARDS Percutaneous ECMO GiugFem
Z. S. RVAD(Levitronix)+LVAS (Heartmate)RVAD RemovalRVFIntermacs 2
G. M. Berlin Heart Intermacs 2 OK
G. M. Berlin Heart Infection (7months) Transplant ECMO crash and burn OK
K. K. ECMO post-cardiotomy failure  Transplant crash and burn
B. A. ECMO post cardiotomy failure  Transplant crash and burn OK
D. F. RVAD (in operata di DIV) crash and burn OK

12. Experience in Naples
Complications
2007 2 surgical revisions for bleeding on the same
patient
2009
Cerebral Hemorrhage after 8 months
1 surgical revision for Pulmonary Cannula migration
Cerebral Hemorrhage after 1 month
2010
Right Ventricular failure after RVAD removal
1 surgical revision for atrial tamponade

13. Surgical Tecnique and methods
Double Tobacco Pursestring on teflon felt
Tourniquets Secured Tying Suture on a small Teflon Felt
Application of spray VIVOSTAT Fibrin Sealant

16. V.M. 24/06/2009
Patient Characteristic RVAD Course
Male, 62 y No Bleeding
60 Kg x 160 cm Optimal RV unloading (PVC 3)
Post-ischemic Cardiomiopathy Lac on ICU 2,2 mmol/L
IACD BiV RBC Units PFC Units
Chronic Renal Failure
Postoperative Course
Chronic Peripheral Arteriopathy
On 3° p.o. Estubated
Type of MCS On 20° p.o. RVAD Removed
Levitronix: Right Atrium PA On 64° p.o. Discharged
Heartmate II

17. G. M. 07/03/2010
Patient Characteristic ECMO Course
Female, 10 y Surgical Revision for Bleeding
24 Kg x 115 cm RBC 15 Units PFC 18 Units
Post-myocarditis
On November 2009 Excor BVAD
Postoperative Course
Transplanted on 07/03/2010
On 5° p.o. Estubated
Donor: 15 Kg 5 Years old
On 7° p.o. ECMO Removed
Type of MCS On 72°p.o. Discharged
After CPB Levitronix: Now on I NYHA
Right Atrium Aorta

18. B.A. 25/05/2010
Patient Characteristic Type of MCS
Female, 66 y Levitronix:Right Atrium Aorta
72 Kg x 160 cm
Elective Mitral Replacement ECMO Course
HCV + RNA- Lac in ICU: 6,3 mmol/L
PO2>150 mmHg PCO2 OK
Postoperative Course I Day Drainage 425 cc
On 2° p.o. Hour Cardiogenic shock II day: Revision for Atrial tamponade
CPR and IABP IV Day: Heart Transplantation
During CPR transferred in OR V Day: IABP Removed
RBC 10 Units, PFC 12 Units
Still Hospidalized for Pulmonary Infection

19. Pulmonary Cannula Migration in LPA

20. Pulmonary Cannula Migration in LPA

21. Experience in Naples with Respiratory ECMO
2010 3 ARDS
Percutaneous ECMO GiugFem MEDOSHILITE LAEVITRONICS
P. R. 22 y H1N1 Infection Duration 28 gg
C. P. 28 y H1N1 Infection Duration 12 gg
P. G. 34 y H1N1 Infection Duration 30 gg

22. Paziente ECMO: P.R. aa 22, IVDU
Ventilation Duration Pre-ECMO 3d
ICU Stay 30d (28d in ECMO)
Blood Flow 1° h (Liters/min) 5, 07
Blood Flow 1° d (Liters/min) 3.73
Gas Flow 1°d (Liters/min) 4.65
PTT ratio 41.9
Oxygenator Model MEDOSHILITE LAEVITRONICS
ECMO - Cannulation GiugularFemoral
VAM modality BIPAP

23. Conclusions
ECMO can be a lifesaving strategy in patients with end-
stage circulatory and respiratory failure.
Results are strictly related to the reversibility of the
underlying disease and the timing of the indication.
Anticoagulation management is still a challenge in the
setting of Circulatory Support with central ECMO.