Percutaneous left atrial decompression in adults with refractory cardiogenic shock supported with veno-arterial extracorporeal membrane oxygenation

Journal of Cardiac Surgery
Mosaad AlhusseinFilio Billia

Abstract

Left ventricular (LV) distention, a recognized complication in patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock, can lead to pulmonary edema, increased myocardial oxygen consumption, and LV thrombus formation. Atrial septostomy was examined as a management strategy for LV distension. Of 72 patients supported with VA-ECMO, seven patients underwent atrial septostomy through a trans-septal approach. The primary indication for atrial septostomy was refractory pulmonary edema. The mean time from ECMO initiation to LA decompression was 1.3 days (range 0-2 days). There was a 100% procedural success rate with improvement in pulmonary edema. Five patients survived to discharge with one patient exhibiting recovery of biventricular function, two patients were transplanted, one patient was decannulated, and one patient was transitioned to long-term durable ventricular assist device. Two patients died, one from multi-organ failure and one with severe anoxic brain injury. Atrial septostomy is an effective method of LV decompression that can be performed safely with a high success rate.

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Citations

May 29, 2018·European Journal of Heart Failure·Maria G Crespo-LeiroFrank Ruschitzka
Oct 11, 2019·Critical Care Medicine·Sung-Min ChoRomergryko G Geocadin
Jun 14, 2019·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Maithri SiriwardenaFilio Billia
Oct 26, 2018·Circulation. Heart Failure·Prashant RaoRobb D Kociol
Apr 3, 2020·Revista brasileira de enfermagem·Gislaine Rodrigues NakasatoCamila Takao Lopes
Aug 1, 2019·Korean Circulation Journal·Min Suk ChoiYang Hyun Cho
Nov 30, 2020·Interactive Cardiovascular and Thoracic Surgery·Ali İhsan HasdeAhmet Ruchan Akar
Apr 4, 2021·Membranes·Juan Pablo Ricarte BrattiYoan Lamarche
Apr 15, 2021·Seminars in Neurology·Giovanni ChiariniRoberto Lorusso
Oct 20, 2020·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Andrew F StephensShaun D Gregory
May 17, 2021·Journal of Cardiac Surgery·Seok In LeeChang Hyu Choi
Jan 19, 2019·The Journal of Thoracic and Cardiovascular Surgery·Wei QuanDavid J Kaczorowski
Jul 13, 2021·Circulation. Heart Failure·Darshan H BrahmbhattFilio Billia

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