PMID- 33249443
OWN - NLM
STAT- MEDLINE
DCOM- 20210719
LR  - 20220316
IS  - 1569-9285 (Electronic)
IS  - 1569-9293 (Print)
IS  - 1569-9285 (Linking)
VI  - 32
IP  - 3
DP  - 2021 Apr 8
TI  - Comparison of left ventricular unloading strategies on venoarterial 
      extracorporeal life support.
PG  - 467-475
LID - 10.1093/icvts/ivaa284 [doi]
AB  - OBJECTIVES: Our goal was to compare the haemodynamic effects of different 
      mechanical left ventricular (LV) unloading strategies and clinical outcomes in 
      patients with refractory cardiogenic shock supported with venoarterial 
      extracorporeal membrane oxygenation (VA-ECMO). METHODS: A total of 448 patients 
      supported with VA-ECMO for refractory cardiogenic shock between 1 March 2015 and 
      31 January 2020 were included and analysed in a single-centre, retrospective 
      case-control study. Fifty-three patients (11.8%) on VA-ECMO required LV 
      unloading. Percutaneous balloon atrial septostomy (PBAS), intra-aortic balloon 
      pump (IABP) and transapical LV vent (TALVV) strategies were compared with regards 
      to the composite rate of death, procedure-related complications and neurological 
      complications. The secondary outcomes were reduced pulmonary capillary wedge 
      pressure, pulmonary artery pressure, central venous pressure, left atrial 
      diameter and resolution of pulmonary oedema on a chest X-ray within 48 h. 
      RESULTS: No death related to the LV unloading procedure was detected. Reduction 
      in pulmonary capillary wedge pressure was highest with the TALVV technique 
      (17.2 +/- 2.1 mmHg; P < 0.001) and was higher in the PBAS than in the IABP group; 
      the difference was significant (9.6 +/- 2.5 and 3.9 +/- 1.3, respectively; 
      P = 0.001). Reduction in central venous pressure with TALVV was highest with the 
      other procedures (7.4 +/- 1.1 mmHg; P < 0.001). However, procedure-related 
      complications were significantly higher with TALVV compared to the PBAS and IABP 
      groups (50% vs 17.6% and 10%, respectively; P = 0.015). We observed no 
      significant differences in mortality or neurological complications between the 
      groups. CONCLUSIONS: Our results suggest that TALVV was the most effective method 
      for LV unloading compared with PBAS and IABP for VA-ECMO support but was 
      associated with complications. Efficient LV unloading may not improve survival.
CI  - (c) The Author(s) 2020. Published by Oxford University Press on behalf of the 
      European Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Hasde, Ali Ihsan
AU  - Hasde AI
AD  - Department of Cardiovascular Surgery, Heart Center, Ankara University School of 
      Medicine, Ankara, Turkey.
FAU - Saricaoglu, Mehmet Cahit
AU  - Saricaoglu MC
AD  - Department of Cardiovascular Surgery, Heart Center, Ankara University School of 
      Medicine, Ankara, Turkey.
FAU - Dikmen Yaman, Nur
AU  - Dikmen Yaman N
AD  - Department of Pediatric Cardiovascular Surgery, Sami Ulus Maternity and Children 
      Research and Training Hospital, Ankara, Turkey.
FAU - Baran, Cagdas
AU  - Baran C
AD  - Department of Cardiovascular Surgery, Heart Center, Ankara University School of 
      Medicine, Ankara, Turkey.
FAU - Ozcinar, Evren
AU  - Ozcinar E
AD  - Department of Cardiovascular Surgery, Heart Center, Ankara University School of 
      Medicine, Ankara, Turkey.
FAU - Cakici, Mehmet
AU  - Cakici M
AD  - Department of Cardiovascular Surgery, Heart Center, Ankara University School of 
      Medicine, Ankara, Turkey.
FAU - Inan, Mustafa Bahadir
AU  - Inan MB
AD  - Department of Cardiovascular Surgery, Heart Center, Ankara University School of 
      Medicine, Ankara, Turkey.
FAU - Akar, Ahmet Ruchan
AU  - Akar AR
AD  - Department of Cardiovascular Surgery, Heart Center, Ankara University School of 
      Medicine, Ankara, Turkey.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
SB  - IM
MH  - Adult
MH  - Aged
MH  - Case-Control Studies
MH  - Extracorporeal Membrane Oxygenation/*methods
MH  - Female
MH  - Heart-Assist Devices
MH  - Hemodynamics/physiology
MH  - Humans
MH  - Intra-Aortic Balloon Pumping/*methods
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Wedge Pressure/*physiology
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/diagnostic imaging/physiopathology/*therapy
MH  - Ventricular Dysfunction, Left/diagnostic imaging/physiopathology/*therapy
PMC - PMC8906780
OTO - NOTNLM
OT  - Left ventricular unloading
OT  - Percutaneous balloon atrial septostomy
OT  - Transapical left ventricular vent
OT  - Venoarterial extracorporeal membrane oxygenation
EDAT- 2020/11/30 06:00
MHDA- 2021/07/20 06:00
PMCR- 2021/11/29
CRDT- 2020/11/29 20:35
PHST- 2020/08/31 00:00 [received]
PHST- 2020/09/16 00:00 [revised]
PHST- 2020/09/20 00:00 [accepted]
PHST- 2020/11/30 06:00 [pubmed]
PHST- 2021/07/20 06:00 [medline]
PHST- 2020/11/29 20:35 [entrez]
PHST- 2021/11/29 00:00 [pmc-release]
AID - 6010521 [pii]
AID - ivaa284 [pii]
AID - 10.1093/icvts/ivaa284 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2021 Apr 8;32(3):467-475. doi: 
      10.1093/icvts/ivaa284.