Transseptal balloon atrial septostomy for decompression of the left atrium during extracorporeal membrane oxygenation support as a “bridge to transplantation” in dilated cardiomyopathy

Litwiński, Paweł; Demkow, Marcin; Sobieszczańska, Małgorzata; Szymański, Jarosław; Stolarek, Józef; Kuśmierczyk, Mariusz

doi:10.5114/aic.2017.66190

Cited by 2 publications

(3 citation statements)

References 8 publications

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“…9,10 Ventricular distension can also occur due to abnormal bronchial collaterals and aortic insufficiency. 11,12 Early intervention in the form of left atrial decompression can potentially reverse this pathophysiology. This can be performed using multiple methods including atrial septostomy with or without stent placement, surgical vent placement, or using assist devices such as aortic balloon pump or Impella ® (Abiomed, Danvers, MA).…”

Section: Discussionmentioning

confidence: 99%

Atrial septostomy in patients supported with venoarterial extracorporeal membrane oxygenation: Analysis of the IMPACT registry data

et al. 2020

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Background: Patients with severe cardiac dysfunction, supported on extra-corporeal membrane oxygenation (ECMO), develop left atrial hypertension and often warrant atrial decompression. The procedural risks and outcomes, however, are not well established. Objective of this study is to understand the utilization, safety, and outcomes of atrial septostomy in children supported on venoarterial ECMO utilizing the IMPACT registry database. Methods: Data from 55 independent sites reporting to the registry was used for this descriptive study. Patients supported with cardiac ECMO that underwent percutaneous atrial septostomy (PAS) were included and data analyzed. Results: Between 2011 and 2018, 223 patients underwent atrial septostomy and were reported to the registry. Mean age was 4.65 years with 52% being males. Diagnoses of heart failure, sepsis, arrhythmia, and renal insufficiency were commonly noted prior to ECMO. The procedure was performed urgently or emergently in most cases (80%). PAS was associated with significant procedural complications such as arrhythmia (6.8%), tamponade (5.4%), and unplanned surgery (3.6%) but no procedural mortality. Overall hospital mortality was 46% (103/223) with 46 of these deaths occurring within 7 days of procedure. Regression analysis showed that African American race (vs Caucasian), race other than Caucasian, chronic lung disease and emergent procedure need were significantly associated with early post-procedural mortality (all p < 0.05). Conclusion: Using a large multicenter cardiac catheterization registry, we found that left atrial decompression can be performed without procedural mortality but is associated with significant morbidity. Impact of race, chronic lung disease and procedural urgency on early mortality warrant further studies.

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Section: Discussionmentioning

confidence: 99%

Atrial septostomy in patients supported with venoarterial extracorporeal membrane oxygenation: Analysis of the IMPACT registry data

et al. 2020

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“…The current data on the incidence of LV distention in adult and pediatric VA-ECMO patients is limited and highly variable (from 1% to 68%) (1,7,8). In a retrospective review of 134 adult VA-ECMO patients, Eliet et al [2018] reported that 27 (20%) required LV unloading, while Truby et al…”

Section: Incidencementioning

confidence: 99%

“…The above strategies in adult and pediatric patients on peripheral VA-ECMO have been shown to reduce PCWP, improve pulmonary edema, reduce LA pressure, improve ECMO output and LVEF, decrease LV distention, and improve ventricular arrhythmias refractory to medical management, as detailed in Tables S1 and S2 (8,10,12,14,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45).…”

Section: Percutaneous Transseptal Ventmentioning

confidence: 99%

Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation

Xie¹,

Forrest²,

Loforte³

2019

Ann. Cardiothorac. Surg.

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Background: Despite the survival benefit of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for treatment of refractory cardiogenic shock, it can also have potentially deleterious effects of left ventricular overload and pulmonary edema. The objective of this review was to investigate the current evidence on the incidence, diagnosis, risk factors, prevention, and interventions for left ventricular overload in adult and pediatric VA-ECMO patients. Methods: Five electronic databases, including MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews, were searched for original published studies from their dates of inception to January 2018. All types of adult and pediatric studies that investigated LV overload in VA-ECMO and were published in the English language were reviewed. Exclusion criteria included abstracts and conference presentations. Results: The reported incidence and sequelae of LV overload in VA-ECMO are highly variable, with presentations ranging from pulmonary arterial diastolic pressures of greater than 25 mmHg and LV distention on echocardiography, to severe pulmonary edema, LV thrombosis, and refractory ventricular arrhythmias. Currently, there are no standardized diagnostic criteria or guidelines for the type and timing of intervention for LV overload. Techniques for LV decompression have included direct surgical LV venting with catheter insertion via sternotomy or a minimally invasive incision; percutaneous catheterization via a transaortic, transseptal, or transpulmonary approach; ventricular assist devices; and intra-aortic balloon pumps. Conclusions: Left ventricular volume distention is a significant problem in VA-ECMO patients, with sequelae including myocardial ischemia, severe pulmonary edema, and intracardiac thrombosis. Further research is required on its incidence, diagnostic criteria, and risk factors, as well as the optimal timing and method for LV decompression, given the diversity of surgical and percutaneous techniques that are available.

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Transseptal balloon atrial septostomy for decompression of the left atrium during extracorporeal membrane oxygenation support as a “bridge to transplantation” in dilated cardiomyopathy

Cited by 2 publications

References 8 publications

Atrial septostomy in patients supported with venoarterial extracorporeal membrane oxygenation: Analysis of the IMPACT registry data

Atrial septostomy in patients supported with venoarterial extracorporeal membrane oxygenation: Analysis of the IMPACT registry data

Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation

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