Buying time! VA-ECMO as a bridge to successful reoperative cardiac surgery in a case of traumatic tricuspid valve injury.
Abiah JacobDonatus K OkaforSanjeev BhattacharyyaKit WongPublished in: Journal of surgical case reports (2023)
Cardiac surgery performed on patients in cardiogenic shock is associated with a high mortality and morbidity. Preoperative Extra Corporeal Membrane Oxygenation (ECMO) in cardiogenic shock gives critically-ill patients a chance for surgical intervention and is associated with better surgical outcomes. We present a 29-year-old male who had a ventricular septal defect closure as a child and presented with multi-organ injuries following polytrauma. He was in cardiogenic shock despite maximal inotropic support. Transesophageal echocardiography demonstrated torrential tricuspid regurgitation (TR) from a flail tricuspid valve (TV) leaflet as the cause of cardiogenic shock. He was stabilized on Veno-Arterial ECMO and underwent reoperative cardiac surgery. Intra-operatively, the anterior leaflet of his TV and its papillary muscle was detached from the right ventricle. He had a successful tissue TV replacement. Early surgery was indicated to treat right ventricular failure due to torrential TR, but due to his restricting non-cardiac injuries, ECMO was successfully used as a short-term support strategy and as a bridge to definitive surgery.
Keyphrases
- extracorporeal membrane oxygenation
- aortic valve
- mitral valve
- cardiac surgery
- left ventricular
- acute respiratory distress syndrome
- aortic stenosis
- acute kidney injury
- transcatheter aortic valve replacement
- ejection fraction
- respiratory failure
- minimally invasive
- end stage renal disease
- coronary artery bypass
- heart failure
- randomized controlled trial
- newly diagnosed
- chronic kidney disease
- pulmonary hypertension
- mechanical ventilation
- spinal cord injury
- computed tomography
- prognostic factors
- type diabetes
- peritoneal dialysis
- skeletal muscle
- surgical site infection
- risk factors
- mental health
- patients undergoing
- resistance training
- cardiovascular disease
- patient reported outcomes
- body composition
- pulmonary arterial hypertension
- locally advanced
- radiation therapy
- high intensity
- patient reported