Comparison of left ventricular unloading strategies on venoarterial extracorporeal life support.

Autor:	Hasde Aİ; Department of Cardiovascular Surgery, Heart Center, Ankara University School of Medicine, Ankara, Turkey., Sarıcaoğlu MC; Department of Cardiovascular Surgery, Heart Center, Ankara University School of Medicine, Ankara, Turkey., Dikmen Yaman N; Department of Pediatric Cardiovascular Surgery, Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey., Baran Ç; Department of Cardiovascular Surgery, Heart Center, Ankara University School of Medicine, Ankara, Turkey., Özçınar E; Department of Cardiovascular Surgery, Heart Center, Ankara University School of Medicine, Ankara, Turkey., Çakıcı M; Department of Cardiovascular Surgery, Heart Center, Ankara University School of Medicine, Ankara, Turkey., İnan MB; Department of Cardiovascular Surgery, Heart Center, Ankara University School of Medicine, Ankara, Turkey., Akar AR; Department of Cardiovascular Surgery, Heart Center, Ankara University School of Medicine, Ankara, Turkey.
Jazyk:	angličtina
Zdroj:	Interactive cardiovascular and thoracic surgery [Interact Cardiovasc Thorac Surg] 2021 Apr 08; Vol. 32 (3), pp. 467-475.
DOI:	10.1093/icvts/ivaa284
Abstrakt:	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. (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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