Percutaneous pulmonary artery venting via jugular vein while on peripheral extracorporeal membrane oxygenation running: a less invasive approach to provide full biventricular unloading

Loforte, Antonio; Baiocchi, Massimo; Gliozzi, Gregorio; Coppola, Giuditta; Bartolomeo, Roberto Di; Lorusso, Roberto

doi:10.21037/acs.2018.08.06

Cited by 9 publications

(7 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding the reduced pre-load and increased afterload of the LVAD in the presence of peripheral V-A ECMO, such conditions translate into decreasing pump preload and increased pump afterload which might negatively influence the LVAD function. Therefore, in such a condition, it is important to accommodate the ECMO /LVAD interaction to avoid the competition between the two devices and the differential hypoxia phenomenon (35)(36)(37).…”

Section: Temporary Right Ventricular Supportmentioning

confidence: 99%

Right ventricular failure after left ventricular assist device implantation: a review of the literature

Coco¹,

Piero²,

Massimi³

et al. 2021

J Thorac Dis

Self Cite

View full text Add to dashboard Cite

Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation remains a major complication which may significantly impair patient outcome. The genesis of RVF is, however, multifactorial, and the mechanisms underlying such a condition have not been fully elucidated, making its prevention challenging and the course not always predictable. Although preoperative risks factors can be associated with RV impairment, the physiologic changes after the LV support, can still hamper the function of the RV. Current medical treatment options are limited and sometimes, patients with a severe post-LVAD RVF may be unresponsive to pharmacological therapy and require more aggressive treatment, such as temporary RV support. We retrieved 11 publications which we assessed and divided in groups based on the RV support [extracorporeal membrane oxygenation (ECMO), right ventricular assist device (RVAD), TandemHeart with ProtekDuo cannula]. The current review comprehensively summarizes the main studies of the literature with particular attention to the RV physiology and its changes after the LVAD implantation, the predictors and prognostic score as well as the different modalities of temporary mechanical cardiocirculatory support, and its effects on patient prognosis for RVF in such a setting. In addition, it provides a decision making of the pre-, intra and post-operative management in high-and moderate-risk patients.

show abstract

Section: Temporary Right Ventricular Supportmentioning

confidence: 99%

Right ventricular failure after left ventricular assist device implantation: a review of the literature

Coco¹,

Piero²,

Massimi³

et al. 2021

J Thorac Dis

Self Cite

View full text Add to dashboard Cite

show abstract

“…Drainage from the PA cannula may, therefore, be influenced and limited by the drainage flow from the right atrium, with potential reduced drainage, stasis and ultimately thrombosis of the cannula placed in PA. To overcome or enhance an optimal flow (1.8-2 L/min) from the PA cannula and to avoid the risk of cannula clotting, the cannula flow from the right atrium needs to be regulated allowing minimal drainage from the PA itself avowing the abovementioned shortcomings. 7,8,29 This is performed using a Hoffman clamp (or gate clamp) ( Figure 3) to balance the proportion of blood from the systemic venous circulation and guarantee adequate drainage quote from the PA cannula. 9 In case of concomitant perfusion of an arterial vessel and the PA, like for differential hypoxemia, with a V-VA mode with the PA cannula as adjunct return, if no control of the PA cannula flow is exerted, the majority of the ECLS flow will go to the lower resistance cannula (the PA cannula), resulting in a remarkable, and potentially dangerous, reduction of perfusion via the systemic arterial cannula.…”

Section: Control Of the Cannula Flow (Drainage Or Perfusion) In "Dymentioning

confidence: 99%

“…The PA cannula, if used as an adjunctive drainage point, is usually connected to the larger main draining cannula (often in right atrium cannula from the femoral vein). Drainage from the PA cannula may, therefore, be influenced and limited by the drainage flow from the right atrium, with potential reduced drainage, stasis and ultimately thrombosis of the cannula placed in PA. To overcome or enhance an optimal flow (1.8‐2 L/min) from the PA cannula and to avoid the risk of cannula clotting, the cannula flow from the right atrium needs to be regulated allowing minimal drainage from the PA itself avowing the abovementioned shortcomings 7,8,29 . This is performed using a Hoffman clamp (or gate clamp) (Figure 3) to balance the proportion of blood from the systemic venous circulation and guarantee adequate drainage quote from the PA cannula 9 .…”

Section: Indications and Special Considerations For Dynamic Eclsmentioning

confidence: 99%

“…The PA cannulation may be achieved with a single lumen cannula lighthouse tip cannula or with a double‐lumen cannula (DLC) (ProtekDuo, LivaNova/Tandem Life, Cardiac Assist Inc, Pittsburgh, PA, USA). As recently described, such a cannulation may be executed via minimally invasive percutaneous techniques, thereby minimizing the complications related to more aggressive approaches 7‐9 . Reduced cost, as compared to transaortic suction device, may also influence the decision‐making.…”

Section: Introductionmentioning

confidence: 99%

“…As recently described, such a cannulation may be executed via minimally invasive percutaneous techniques, thereby minimizing the complications related to more aggressive approaches. [7][8][9] Reduced cost, as compared to transaortic suction device, may also influence the decision-making.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Dynamic extracorporeal life support: A novel management modality in temporary cardio‐circulatory assistance

et al. 2020

Self Cite

View full text Add to dashboard Cite

Traditionally in many centers, the initially applied cannulation for extracorporeal life support (ECLS) is maintained without any further reflection for all the duration of the support. However, only the risk or actual occurrence of severe complications, like limb ischemia for femoral artery cannulation, left ventricular (LV) stasis, or differential hypoxemia as well as suboptimal drainage volume despite veno-venous (VV) or veno-arterial (VA), may prompt a change of the original setup. 1 Standard central cannulation extracorporeal membrane oxygenation (ECMO) might be a potential

show abstract

Venting during venoarterial extracorporeal membrane oxygenation

et al. 2022

View full text Add to dashboard Cite

Cardiogenic shock and cardiac arrest contribute pre-dominantly to mortality in acute cardiovascular care. Here, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as an established therapeutic option for patients suffering from these life-threatening entities. VA-ECMO provides temporary circulatory support until causative treatments are effective and enables recovery or serves as a bridging strategy to surgical ventricular assist devices, heart transplantation or decision-making. However, in-hospital mortality rate in this treatment population is still around 60%. In the recently published ARREST trial, VA-ECMO treatment lowered mortality rate in patients with ongoing cardiac arrest due to therapy refractory ventricular fibrillation compared to standard advanced cardiac life support in selected patients. Whether VA-ECMO can reduce mortality compared to standard of care in cardiogenic shock has to be evaluated in the ongoing prospective randomized studies EURO-SHOCK (NCT03813134) and ECLS-SHOCK (NCT03637205). As an innate drawback of VA-ECMO treatment, the retrograde aortic flow could lead to an elevation of left ventricular (LV) afterload, increase in LV filling pressure, mitral regurgitation, and elevated left atrial pressure. This may compromise myocardial function and recovery, pulmonary hemodynamics—possibly with concomitant pulmonary congestion and even lung failure—and contribute to poor outcomes in a relevant proportion of treated patients. To overcome these detrimental effects, a multitude of venting strategies are currently engaged for both preventive and emergent unloading. This review aims to provide a comprehensive and structured synopsis of existing venting modalities and their specific hemodynamic characteristics. We discuss in detail the available data on outcome categories and complication rates related to the respective venting option. Graphical abstract

show abstract

Percutaneous pulmonary artery venting via jugular vein while on peripheral extracorporeal membrane oxygenation running: a less invasive approach to provide full biventricular unloading

Cited by 9 publications

References 5 publications

Right ventricular failure after left ventricular assist device implantation: a review of the literature

Right ventricular failure after left ventricular assist device implantation: a review of the literature

Dynamic extracorporeal life support: A novel management modality in temporary cardio‐circulatory assistance

Venting during venoarterial extracorporeal membrane oxygenation

Contact Info

Product

Resources

About