PMID- 27742755
OWN - NLM
STAT- MEDLINE
DCOM- 20180806
LR  - 20220409
IS  - 2048-8734 (Electronic)
IS  - 2048-8726 (Linking)
VI  - 7
IP  - 1
DP  - 2018 Feb
TI  - Percutaneous balloon atrial septostomy on top of venoarterial extracorporeal 
      membrane oxygenation results in safe and effective left heart decompression.
PG  - 70-79
LID - 10.1177/2048872616675485 [doi]
AB  - BACKGROUND: Transcatheter techniques are emerging for left atrial (LA) 
      decompression under venoarterial extracorporeal membrane oxygenation (VA-ECMO). 
      We aimed to assess whether balloon atrioseptostomy (BAS) is a safe and efficient 
      strategy. METHODS: All patients who underwent percutaneous static BAS under 
      VA-ECMO at four tertiary institutions were retrospectively reviewed. RESULTS: 
      From 2000 to 2014, BAS was performed in 64 patients (32 adults and 32 children). 
      Indications for ECMO support included acute myocarditis (31.3%) and 
      non-myocarditis cardiac disease, mostly end-stage dilated cardiomyopathy (32.8%). 
      BAS was required because of pulmonary oedema/haemorrhage and left ventricular 
      (LV) distension. The mean balloon diameter was 21.8 +/- 8.4mm. Adequate LA 
      decompression was achieved in all patients. Mean LA pressure fell from 
      24.2 +/- 6.9 mmHg to 7.8 +/- 2.6 mmHg ( p < 0.001). The left-to-right atrial pressure 
      gradient fell from 17.2 +/- 7.1 mmHg to 0.09 +/- 0.5 mmHg ( p < 0.001). 
      Echocardiography showed an unrestrictive left-to-right atrial shunting in all 
      patients. Improvement of day 1 chest X-ray was observed in 76.6% of patients, 
      clinical status in 98.4% of patients and pulmonary haemorrhage in 14 out of 14 
      patients. Complications occurred in 9.4% of patients, representing pericardial 
      effusion, fast atrial fibrillation, ventricular fibrillation requiring 
      defibrillation, transient complete heart block and femoral venous dissection 
      requiring covered stent placement. In the 37 (57.8%) patients who were 
      successfully decannulated, the median ECMO duration was 9 (range: 4-24) days. 
      After a median follow-up of 12.3 (range: 0.1-142) months, 35.9% patients died, 
      17.2% received a LV assist device as a bridge to transplantation, 31.2% were 
      transplanted and 56.2% were home discharged and alive. CONCLUSIONS: Percutaneous 
      BAS may be a safe and efficient strategy for discharging the LA in both adults 
      and children supported by VA-ECMO.
FAU - Baruteau, Alban-Elouen
AU  - Baruteau AE
AD  - 1 Department of Paediatric Cardiology, Royal Brompton Hospital and Harefield NHS 
      Foundation Trust, Imperial College London, London, UK.
AD  - 2 Cardiology Clinical Academic Group, Cardiovascular and Cell Sciences Research 
      Institute, St George's University of London, London, UK.
AD  - 3 IHU LIRYC, Electrophysiology and Heart Modeling Institute, INSERM U1045, 
      Bordeaux, France.
FAU - Barnetche, Thomas
AU  - Barnetche T
AD  - 4 Department of Rheumatology, University Hospital Pellegrin, Bordeaux, France.
FAU - Morin, Luc
AU  - Morin L
AD  - 5 Department of Pediatric Intensive Care, Paris South University Hospitals, 
      Assistance Publique Hopitaux de Paris, Le Kremlin-Bicetre, France.
FAU - Jalal, Zakaria
AU  - Jalal Z
AD  - 3 IHU LIRYC, Electrophysiology and Heart Modeling Institute, INSERM U1045, 
      Bordeaux, France.
AD  - 6 Department of Pediatric Cardiology, Haut-Leveque Hospital, Bordeaux University, 
      Bordeaux, France.
FAU - Boscamp, Nicholas S
AU  - Boscamp NS
AD  - 7 Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, New York 
      Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
FAU - Le Bret, Emmanuel
AU  - Le Bret E
AD  - 8 Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris, 
      France.
FAU - Thambo, Jean-Benoit
AU  - Thambo JB
AD  - 3 IHU LIRYC, Electrophysiology and Heart Modeling Institute, INSERM U1045, 
      Bordeaux, France.
AD  - 6 Department of Pediatric Cardiology, Haut-Leveque Hospital, Bordeaux University, 
      Bordeaux, France.
FAU - Vincent, Julie A
AU  - Vincent JA
AD  - 7 Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, New York 
      Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
FAU - Fraisse, Alain
AU  - Fraisse A
AD  - 1 Department of Paediatric Cardiology, Royal Brompton Hospital and Harefield NHS 
      Foundation Trust, Imperial College London, London, UK.
FAU - Torres, Alejandro J
AU  - Torres AJ
AD  - 7 Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, New York 
      Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20161014
PL  - England
TA  - Eur Heart J Acute Cardiovasc Care
JT  - European heart journal. Acute cardiovascular care
JID - 101591369
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Cardiac Catheterization/*methods
MH  - Cardiac Surgical Procedures/*methods
MH  - Child
MH  - Child, Preschool
MH  - Decompression, Surgical/*methods
MH  - Echocardiography
MH  - Extracorporeal Membrane Oxygenation/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Atria/diagnostic imaging/*surgery
MH  - Heart Diseases/diagnosis/*surgery
MH  - Heart Septum/diagnostic imaging/*surgery
MH  - Humans
MH  - Infant
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Time Factors
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - ECMO support
OT  - cardiogenic shock
OT  - haemodynamics
OT  - outcomes
OT  - pulmonary oedema
OT  - transcatheter techniques
EDAT- 2016/10/16 06:00
MHDA- 2018/08/07 06:00
CRDT- 2016/10/16 06:00
PHST- 2016/10/16 06:00 [pubmed]
PHST- 2018/08/07 06:00 [medline]
PHST- 2016/10/16 06:00 [entrez]
AID - 2048872616675485 [pii]
AID - 10.1177/2048872616675485 [doi]
PST - ppublish
SO  - Eur Heart J Acute Cardiovasc Care. 2018 Feb;7(1):70-79. doi: 
      10.1177/2048872616675485. Epub 2016 Oct 14.