Percutaneous Decompression of the Left Ventricle in Cardiogenic Shock Patients on Venoarterial Extracorporeal Membrane Oxygenation

Abstract

Antegrade transseptal left ventricular decompression is feasible in patients on extracorporeal membrane oxygenation and persistent pulmonary edema.

Modalities and Effects of Left Ventricle Unloading on Extracorporeal Life support: a Review of the Current Literature

“…Kotani et al depicted dramatic improvement in LA pressure immediately after balloon atrial septostomy in four patients on ECMO support who required LV decompression . In addition, there are several cases in the literature describing the use and efficacy of these techniques, either in isolation or in combination with additional venting options …”

Mechanical circulatory support in patients with severe aortic stenosis and left ventricular dysfunction undergoing percutaneous coronary intervention

“…The TandemHeart provides higher cardiac output support compared with the IABP and Impella, but it is not widely available and its implantation is more intricate due to the need for transseptal puncture, and a larger bore access. Venoarterial extracorporeal membrane oxygenation (VA‐ECMO) provides complete heart and lung support, but can lead to significant increase in ventricular afterload and often requires additional measures for LV unloading . Potential complications of all MCS devices are access site bleeding, embolization, limb ischemia, infection, stroke, and hemolysis .…”

ECMO Cannulation Techniques

“…Additionally, venting of the left side of the heart can be performed via placement of a cannula into the left atrium through the left atrial wall or the right superior pulmonary vein. This is done through a purse string, and a 20 French malleable vent can be used 2 . This can also be used to cross the mitral valve to place a true left ventricular vent.…”

“…Percutaneous venting techniques are ideal when the need for venting is thought to be short in duration, and surgery may be less desirable due to antiplatelet therapy, liver dysfunction, and severe organ failure [2]. Classically balloon atrial septostomy has been performed, but this may not be universally efficacious.…”