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Outcomes of left ventricular unloading with a transseptal cannula during extracorporeal membrane oxygenation in adults
Author(s) -
Kim AhRam,
Park Hanbit,
Lee SangEun,
Ahn JungMin,
Park DukWoo,
Lee SeungWhan,
Kim JaeJoong,
Park SeungJung,
Hong Jung Ae,
Kang PilJe,
Jung SungHo,
Kim MinSeok
Publication year - 2021
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.13838
Subject(s) - medicine , extracorporeal membrane oxygenation , cannula , ventricular assist device , percutaneous , cardiology , pulmonary edema , surgery , cardiogenic shock , anesthesia , heart failure , lung , myocardial infarction
We evaluated the benefit of left ventricular (LV) unloading using a percutaneous transseptal left atrial (LA) drain catheter via femoral vein incorporated into the ECMO venous circuit. This single‐center retrospective observational study analyzed clinical outcomes of the LA venting group (N = 62) who underwent percutaneous transseptal LA drain placement comparing with the conventionally treated control group (N = 62) with an arterial pulse pressure below 10 mm Hg for at least 24 hours from December 2012 to August 2018. The ECMO weaning rate (61.3% vs. 38.7%, P = .012) and cardiac transplantation rate (29.0% vs. 11.3%, P = .014) were higher in the LA venting group than in the control group. Inhospital mortality was not significantly different (56.5% vs. 69.4%, P = .191). Pulmonary congestion mostly improved after LA decompression (61.3%, P = .003). A serum lactate level at 24 hours after LA venting of more than 2.2 mmol/L was associated with poor outcomes. LA venting via transseptal cannula reduced pulmonary venous congestion and achieved higher rates of successful ECMO weaning and cardiac transplantation. Placement of a transseptal venous drain cannula should be considered in patients with uncontrolled pulmonary edema secondary to severe LV loading undergoing VA‐ECMO.