Introduction
The number of heart-lung transplants (HLT) remained static during the
last five years, with 59 procedures in 2017.1Currently, most of the HLTs are performed on patients with severe
pulmonary hypertension associated with congenital heart disease,
followed by idiopathic pulmonary arterial hypertension (IPAH) and cystic
fibrosis (CF). There is also a small trend showing an increasing number
of HLTs performed for idiopathic interstitial pneumonia
(IIP).2 Some of
these patients are critically ill on the waiting list, and venoarterial
extracorporeal membrane oxygenation (VA-ECMO) can be used as a bridge to
transplantation. The evidence to support this strategy is limited but
evaluation of the outcomes is crucial, especially with the new heart
status allocation system.3 Traditionally,
ambulation was considered too
dangerous with femoral cannulation.
We present the case of a
56-year-old male with interstitial lung disease (ILD) and severe
secondary pulmonary hypertension, who was successfully bridged to HLT
with ambulatory femoral VA-ECMO.