{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T15:45:27Z","timestamp":1774712727829,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T00:00:00Z","timestamp":1732060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Peripheral veno\u2010arterial extracorporeal membrane oxygenation (ECMO) is a powerful life\u2010saving tool; however, it can sometimes induce severe pulmonary edema in patients with critical heart failure. We report favorable outcomes in critically ill patients by using a central ECMO system with an innovative blood perfusion method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed 10 patients with severe heart failure and pulmonary edema who were treated with the central ECMO system at our institution between April 2022 and October 2023. The system consists of central cannulation with two inflows from the right atrium and left ventricle, and two outflows to the aorta and pulmonary artery, connected by two Y\u2010connectors to a single ECMO circuit (RALV\u2010AOPA ECMO). In this system, blood flow to the pulmonary artery is adjusted and mean pulmonary artery pressure is limited to &lt;20\u2009mm\u2009Hg, which reduces right ventricular afterload and prevents the worsening of pulmonary edema and hemorrhage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six patients were diagnosed with fulminant lymphocytic myocarditis, and four were diagnosed with coronavirus disease 2019\u2010related myocardial injury. The ejection fraction was 6.5\u2009\u00b1\u20094.1%. The average intraoperative pulmonary vascular resistance was 4.6\u2009\u00b1\u20091.3 Wood units. After 24\u2009h, the mean pulmonary arterial pressure was 12.8\u2009\u00b1\u20094.3\u2009mm\u2009Hg, and pulmonary vascular resistance was 1.5\u2009\u00b1\u20090.3 Wood units. The duration of central RALV\u2010AOPA ECMO was 3.7\u2009\u00b1\u20092.1\u2009days. Finally, six patients were weaned, three received HeartMate3, and one received heart transplantation. At follow\u2010up, all patients remained alive (428\u2009\u00b1\u2009208\u2009days), and two patients experienced cerebrovascular accidents without any lasting sequelae.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The central RALV\u2010AOPA ECMO is an innovative system that achieves early improvement in pulmonary vascular resistance and is safe and feasible for patients with acute biventricular failure and pulmonary edema.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aor.14906","type":"journal-article","created":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T12:28:28Z","timestamp":1732105708000},"page":"469-476","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Useful central mechanical circulatory support system for critical biventricular heart failure associated with high pulmonary vascular resistance"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4658-852X","authenticated-orcid":false,"given":"Naoki","family":"Tadokoro","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery National Cerebral and Cardiovascular Center  Suita, Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Kainuma","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery National Cerebral and Cardiovascular Center  Suita, Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kohei","family":"Tonai","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery National Cerebral and Cardiovascular Center  Suita, Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuya","family":"Koyamoto","sequence":"additional","affiliation":[{"name":"Department of Clinical Engineering National Cerebral and Cardiovascular Center  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naonori","family":"Kawamoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery National Cerebral and Cardiovascular Center  Suita, Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Kakuta","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery National Cerebral and Cardiovascular Center  Suita, Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1659-9324","authenticated-orcid":false,"given":"Kimito","family":"Minami","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care National Cerebral and Cardiovascular Center  Suita, Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Nishioka","sequence":"additional","affiliation":[{"name":"Department of Clinical Engineering National Cerebral and Cardiovascular Center  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasumasa","family":"Tsukamoto","sequence":"additional","affiliation":[{"name":"Department of Transplantation National Cerebral and Cardiovascular Center  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9481-8860","authenticated-orcid":false,"given":"Satsuki","family":"Fukushima","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery National Cerebral and Cardiovascular Center  Suita, Osaka 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