Abstract Background A limit of peripheral veno-arterial Extracorporeal Membrane Oxigenator (VA-ECMO) is the inadequate unloading of the left ventricle. The increase of end-diastolic pressure reduces the possibility of a recovery and may cause severe pulmonary edema. In this study, we evaluate our results after implantation of VA-ECMO and Transapical Left Ventricular Vent (TLVV) as a bridge to recovery, heart transplantation or long- term left ventricular assit devices (LVAD). Methods and Patients From 2011 to 2014, 24 consecutive patients with profound cardiogenic shock were supported by peripheral VA-ECMO as bridge to decision. In all cases, TLVV was implanted after a mean period of 12.2± 3.4 hours through a left mini-thoracotomy and connected to the venous inflow line of the VA-ECMO. Results Thirty-day mortality was 37.5% (9/24). In all patients, hemodynamics improved after TLVV implantation with an increased cardiac output, mixed venous saturation and a significant reduced heart filling pressures (p< 0.05). Recovery of the cardiac function was observed in 11 patients (11/24; 45.8%). Three patients were transplanted (3/24; 12.5%) and 3 patients (3/24; 12.5%) underwent LVAD implantation as destination therapy, all these patients were discharged from the hospital in good clinical conditions. Conclusions In these critical patients, systematic TLVV improved hemodynamic seemed to provide better in hospital survival and chance of recovery, compared to V-A ECMO results in the treatment of cardiogenic shock reported in the literature . TLVV is a viable alternative to standard VA- ECMO in order to identify the appropriate long-term strategy (heart transplantation or long-term VAD)

LEFT VENTRICULAR UNLOADING DURING PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATOR SUPPORT (ECMO): A BRIDGE TO LIFE IN PROFOUND CARDIOGENIC SHOCK / Centofanti, Paolo; Attisani, Matteo; Torre, Michele La; Ricci, Davide; Boffini, Massimo; Baronetto, Andrea; Simonato, Erika; Clerici, Alberto; Rinaldi, Mauro .. - In: THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY. - ISSN 0022-1058. - 49:3(2017), pp. 201-205.

LEFT VENTRICULAR UNLOADING DURING PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATOR SUPPORT (ECMO): A BRIDGE TO LIFE IN PROFOUND CARDIOGENIC SHOCK

CLERICI, ALBERTO;
2017

Abstract

Abstract Background A limit of peripheral veno-arterial Extracorporeal Membrane Oxigenator (VA-ECMO) is the inadequate unloading of the left ventricle. The increase of end-diastolic pressure reduces the possibility of a recovery and may cause severe pulmonary edema. In this study, we evaluate our results after implantation of VA-ECMO and Transapical Left Ventricular Vent (TLVV) as a bridge to recovery, heart transplantation or long- term left ventricular assit devices (LVAD). Methods and Patients From 2011 to 2014, 24 consecutive patients with profound cardiogenic shock were supported by peripheral VA-ECMO as bridge to decision. In all cases, TLVV was implanted after a mean period of 12.2± 3.4 hours through a left mini-thoracotomy and connected to the venous inflow line of the VA-ECMO. Results Thirty-day mortality was 37.5% (9/24). In all patients, hemodynamics improved after TLVV implantation with an increased cardiac output, mixed venous saturation and a significant reduced heart filling pressures (p< 0.05). Recovery of the cardiac function was observed in 11 patients (11/24; 45.8%). Three patients were transplanted (3/24; 12.5%) and 3 patients (3/24; 12.5%) underwent LVAD implantation as destination therapy, all these patients were discharged from the hospital in good clinical conditions. Conclusions In these critical patients, systematic TLVV improved hemodynamic seemed to provide better in hospital survival and chance of recovery, compared to V-A ECMO results in the treatment of cardiogenic shock reported in the literature . TLVV is a viable alternative to standard VA- ECMO in order to identify the appropriate long-term strategy (heart transplantation or long-term VAD)
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11583/2684529
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