D-16 | VV ECMO Use in Refractory Respiratory Failure With Pulmonary Hypertension Following Multi Valve Surgery

We present a patient with severe pulmonary hypertension and valvular atrial fibrillation secondary to rheumatic heart disease that required venovenous extracorporeal membrane oxygenation support (VV ECMO) after the patient was unable to wean off cardiopulmonary bypass following multi-valve open heart surgery. A 74-year-old female with history of heart failure with preserved ejection fraction (HFpEF), obstructive sleep apnea, rheumatic heart disease, and atrial fibrillation presented with worsening dyspnea and fatigue, found to be in acutely decompensated heart failure. Transthoracic echo revealed preserved EF. Transesophageal echocardiogram demonstrated severe mitral stenosis with a highly mobile vegetation and severe pulmonary hypertension. Patient underwent mitral valve replacement, tricuspid repair, and Maze procedure. Following surgery, the patient was unable to wean from cardiopulmonary bypass, thus VV ECMO was used as bridge to recovery. Patient was successfully weaned off VV ECMO within 48 hours, extubated, and discharged home. Due to refractory respiratory failure, VV ECMO was utilized in this patient. Given acute presentation and risk of hypoxic injury, VV ECMO was crucial in alleviating the work of lungs, namely in the setting of severe pulmonary hypertension. The principle of VV ECMO is based on oxygenation, ventilation, and lung rest. This case highlights the viability of VV ECMO as bridge therapy in reversible respiratory failure.