Percutaneous balloon atrial septostomy on top of venoarterial extracorporeal membrane oxygenation results in safe and effective left heart decompression

Baruteau, Alban‐Elouen; Barnetche, Thomas; Morin, Luc; Jalal, Zakaria; Boscamp, Nicholas S.; Bret, Emmanuel Le; Thambo, Jean-Benoît; Vincent, Julie A.; Fraisse, Alain; Torres, Alejandro

doi:10.1177/2048872616675485

Cited by 65 publications

(50 citation statements)

References 39 publications

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“…8,12 Percutaneous balloon atrial septostomy may be a safe and efficient strategy for discharging the left atrium in both adults and children supported by VA-ECMO. 16 One adult patient in the preoperative group had left ventricular distention during extracorporeal support. This complication was treated by balloon atrial septostomy at the coronary angiography unit.…”

Section: Ender Gedik Et Al/experimental and Clinical Transplantation mentioning

confidence: 99%

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Gedik

Atar²,

Özdemirkan³

et al. 2017

Exp Clin Transplant

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Objectives: Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. This technique may be used after heart transplant for conditions refractory to medical treatment like primary graft failure. Previously, we reported our experience with patients who received extracorporeal support as a bridge to emergency heart transplant. In this study, we present our perioperative experience with heart transplants in which extracorporeal support was used. Materials and Methods:We retrospectively screened the data of 31 patients who were seen at our center between January 2014 and June 2016. We screened for patients who were admitted to the intensive care unit before transplant and who required venoarterial extracorporeal membrane oxygenation for circulatory support and postoperative patients who required extracorporeal support. Patient demographics and characteristics, clinical data, and extracorporeal support data were collected from our electronic database and patient medical records. Results: There were 14 patients who required perioperative extracorporeal support. Preoperative support was performed in 3 patients before transplant, and postoperative support was performed in 11 patients after transplant. The mean age was 37.7 years in patients within the preoperative group and 29.7 years in patients within the postoperative group. One patient with preoperative support and 5 with postoperative support were pediatric patients. The main indication for transplant was dilated cardiomyopathy in both groups (100% and 63.7%). Overall mortality rates were 33% in the preoperative group and 63.7% in the postoperative group. Conclusions: For patients on heart transplant wait lists who are worsening despite optimal medical therapy, venoarterial extracorporeal membrane oxygenation support is a safe and viable last resort. In addition, extracorporeal support can be used during the posttransplant period as salvage therapy in heart recipients with hemodynamic deterioration. In our experience, preoperative extracorporeal support had lower mortality rates compared with postoperative support.

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Section: Ender Gedik Et Al/experimental and Clinical Transplantation mentioning

confidence: 99%

Untitled

Gedik

Atar²,

Özdemirkan³

et al. 2017

Exp Clin Transplant

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“…In another single-center case series (37 pediatric patients), trans-catheter procedures to decompress the left heart were performed in 97% of patients within 24 h of ECMO initiation [4]. In a multi-center case series (64 patients: 32 adult, 32 pediatric) and the only study to include adult patients with available data on timing of intervention, Baruteau et al [5] report that the mean ECMO-BAS timing was 1.5 days, with a range of 0 to 12 days. In a literature summary by the same authors, previously reported mean ECMO-BAS timings for pediatric patients ranged from 8 h to 2.5 days.…”

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confidence: 99%

“…Interventional approaches to decompress the left heart include cardiac support interventions, such as intra-aortic balloon pumps, and percutaneous techniques to vent the left heart, such as pulmonary artery vents, retrograde transaortic vents, transseptal LA decompression [6, 9] with BAS and LA vent insertion [9], static over-the-wire [5, 9] balloon dilation, blade balloon septostomy [7, 9] and atrial stenting [9, 10]. The combination of BAS with ECMO has been shown to be safe and efficient in 64 patients in a multi-institutional study [5].…”

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Left heart decompression in patients supported with extracorporeal membrane oxygenation for cardiac disease

Ong

Hibino

2017

pwki

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“…Several techniques have been described in order to decompress the failing left heart, including intraaortic balloon pumps (IABPs), axial flow catheters (Impella, Abiomed Inc., Danvers, MA, USA) and left atrial to femoral artery bypass (TandemHeart, Cardiac Assist Inc., Pittsburgh, PA, USA) (10,11). Left heart decompression has also been achieved by the transcatheter creation of an atrial septal defect using different approaches, including vent placement, static balloon dilation and stent implantation (12)(13)(14).…”

mentioning

confidence: 99%

Left ventricular distention under venoarterial extracorporeal membrane oxygenation support: when should we consider percutaneous left heart decompression?

Riahi

Baruteau

2017

J. Thorac. Dis.

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In the June 2017 issue of the ASAIO Journal, Truby et al. described a retrospective, monocenter cohort of 121 patients who underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation because of refractory cardiogenic shock (1). Authors stratified patients in three distinct groups according to a new proposed definition of left ventricular distention (LVD) severity based on clinical, hemodynamic and radiologic criteria: (I) clinical LVD (LVD++) if "mechanical intervention to decompress the LV was initiated immediately after VA-ECMO because of pulmonary edema, ventricular arrhythmia, or significant stagnation of blood within the LV"; (II) subclinical LVD (LVD+) if "evidence of pulmonary edema on chest radiograph and pulmonary artery diastolic pressure greater than 25 mmHg within the first 2 hours of VA-ECMO support"; and (III) no LVD (LVD−) in the absence of the above criteria.Significant baseline differences existed between groups: 33% of LVD++ patients had post myocardial infarction refractory cardiogenic shock while 55% of LVD+ had postcardiotomy shock. More importantly, cardiopulmonary resuscitation was performed in 67% of LVD++ compared to 11% and 19% of LVD+ and LVD−, respectively. Furthermore, all LVD++ patients had an LV ejection fraction lower than 30% compared to 50% in the LVD+ group and 40% in the LVD−. After a mean duration of VA-ECMO support of 4.11±2.98 days, the overall survival to discharge was 43% and did not differ between groups. However, only 20% of LVD++ survivors achieved myocardial recovery defined as absence of longterm mechanical support. In comparison, 60% of LVD+ and 20% of LVD− achieved myocardial recovery. One major finding was that survival to discharge was 44.4% (4/9) in those patients who benefited from early decompression, all of which were in the LVD++, versus only 10% (1/10) in those of the LVD+ group who underwent a late decompression. The only preoperative factor that was significantly predictive of the need of decompression in the multivariate model was extracorporeal cardiopulmonary resuscitation (odds ratio: 3.64, confidence interval: 1.21-10.98; P=0.022).Although the results are interesting, authors advocate significant limitations that may have impacted the interpretation of study findings. Only 105 out of 226 VA-ECMO runs were included in the analysis, the other ones being excluded because of insufficient hemodynamic data.

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Percutaneous balloon atrial septostomy on top of venoarterial extracorporeal membrane oxygenation results in safe and effective left heart decompression

Abstract: Percutaneous BAS may be a safe and efficient strategy for discharging the LA in both adults and children supported by VA-ECMO.

Cited by 65 publications

References 39 publications

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Left heart decompression in patients supported with extracorporeal membrane oxygenation for cardiac disease

Left ventricular distention under venoarterial extracorporeal membrane oxygenation support: when should we consider percutaneous left heart decompression?

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