LEFT VENTRICLE UNLOADING BY PERCUTANEOUS TRANSFEMORAL TRANSSEPTAL CANNULATION OF LEFT ATRIUM IN PATIENTS BRIDGED TO HEART TRANSPLANTATION WITH PERIPHERAL VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION
https://doi.org/10.15825/1995-1191-2013-4-70-83
Abstract
Aim. Peripheral VA ECMO is effective method of circulatory support in heart transplant candidates with life th- reatening CHF. However this type of extracorporeal life support may be complicated by pulmonary congestion (“white lung”) as a result of left ventricle (LV) dilatation and volume overload. Difference approach proposed for LV unloading following VA ECMO circulatory support. We report our experience of LV unloading by percutaneous introduced of supplement drainage cannula in the left atrium (LA ) through the femoral vena and interatrial septum.
Material and methods. In this study was included 33 heart transplant candidates (6/27 F/M, age 46.2 ± 3.7 yrs) on peripheral VA ECMO support. For LV unloading we used supplement standard venous ECMO-cannula (15–19 F) percutaneous introduced in LA through the femoral vena of conterlateral leg and connected to the venous line of ECMO circuit.
Results. To 20 (60.6%) from 33 patients needed of early (n = 10) or delayed (n = 10) LA drainage. After beginning of LV drainage we noted of significant (p < 0.05) decreasing of PAWP from 31 ± 3 to 14 ± 3 mm Hg and resolution of pulmonary edema. Mean blood flow on LA cannula was 1.5 ± 0.2 l/min. To 18 (90%) from 20 patients was successfully bridged to heart transplantation. Duration VA ECMO before OHT was 8.6 ± 1.7 days. 16 (88.9%) recipients were discharged from hospital.
Conclusion. Active LA drainage is as effective tool of LV un- loading and protection of pulmonary congestion and edema in patients bridged to heart transplantation by peripheral VA ECMO.
About the Authors
V. N. Poptsov
Departament of anaestesiology and intensive therapy (Head – prof. V.N. Poptsov)Academician
V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs (Head – academician of RAMSci, prof. S.V. Gautier), Moscow, Russian Federation.
E. A. Spirina
Departament of anaestesiology and intensive therapy (Head – prof. V.N. Poptsov)Academician
V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs (Head – academician of RAMSci, prof. S.V. Gautier), Moscow, Russian Federation.
V. V. Slobodjannik
Division of cardiac Surgery No 2 (Head – corresponding member of RAMSci, prof. D.V. Shumakov) Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs (Head – academician of RAMSci, prof. S.V. Gautier), Moscow, Russian Federation.
V. M. Zakharevich
Division of cardiac Surgery No 3 (Head – prof. R.S. Saitgareev) Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs (Head – academician of RAMSci,
prof. S.V. Gautier), Moscow, Russian Federation.
Chair of Transplantology and Artificial Organs (Head – academician of RAMSci, prof. S.V. Gautier) I.M. Sechenov First Moscow State Medical University (Rector – corresponding member of RAMSci, prof. P.V. Glybochko), Moscow, Russian Federation.
O. A. Eremeeva
Departament of anaestesiology and intensive therapy (Head – prof. V.N. Poptsov)Academician
V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs (Head – academician of RAMSci, prof. S.V. Gautier), Moscow, Russian Federation.
S. A. Masiutin
Departament of anaestesiology and intensive therapy (Head – prof. V.N. Poptsov)Academician
V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs (Head – academician of RAMSci, prof. S.V. Gautier), Moscow, Russian Federation.
References
1. СПИСОК ЛИТЕРАТУРЫ
2. Barth E., Durand M., Heylbroeck C., Rossi-Blancher M., Boignard A., Vanzetto G., Albaladejo P., Chavanon O. Extracorporeal life support as a bridge to high-urgency heart transplantation. Clin. Transplant. 2012; 26 (3): 484–488.
3. Harmouche M., Flécher E., Abouliatim I., Fouquet O., Lelong B., Chabanne C., Verhoye J.P., Leguerrier A. Heart transplantation for patients on high emergency list with or without extracorporeal membrane oxygenation support. Ann. Cardiol. Angeiol. 2011; 60 (1): 15–20.
4. Camboni D., Phillip A., Schimid C. Possibilities and li- mitations of a miniaturized long-term extracorporeal life support system as bridge to transplantation in a case with biventricular heart failure. Interactiv Cardiovasc. Tho- rac. Surg. 2009; 8: 168–170.
5. Hsu Pj-Shun, Chen Gui-Jieng, Tsai Yi-Jieng et al. Ex- tracorporeal membrane oxygenation for refractory car- diogenic shock after cardiac surgery: predictors of early mortality and outcome from 51 patients. Eur. J. Cardio- thorac. Surg. 2010; 37: 328–333.
6. Koenig P.R., Ralston M.A., Kimball T.R., Meyer R.A., Daniels S.R., Schwartz D.C. Balloon atrial septostomy for left ventricular decompression in patients receiving extracorporealmembrane oxygenation for myocardial failure. J. Pediatr. 1993; 122: 95–99.
7. Ward K.E., Tuggle D.W., Gessouroun M.R., Over- hold E.D., Mantor P.C. Transseptal decompression of left heart during ECMO for severevmyocarditis. Ann. Thorac. Surg. 1995; 59: 749–751.
8. Aiya R.M., Graziano J.N. Decompression of the left atri- um during extracorporeal membrane oxygenation using a transseptal cannula incorporated into the circuit. J. Crit. Care Med. 2006, 34: 2603–2606.
9. Kotani Y., Chetan D., Rodriges W., Sivarajan V.B., Gru- enwald C., Van Arsdell, Honjo O. Left Atrial Decomres- sion During Venoarterial ECMO for children: Сurret Strategy and Clinical Outcomes. Artifical Organs. 2013; 37 (1): 29–36.
10. Seib P.M., Faulkner S.C., Erickson C.C., Van Devant- er S.H., Harrell J.E., Fasules J.W., Frazier E.A., Mor- row W.R. Blade and balloon atrial septostomy for left heart decompression in patients with severe ventricu- lar dysfunction on extracorporeal membrane oxygen- ation. Catheter Cardiovasc. Interv. 1999; 46 (2): 179– 186.
11. Soleimani B., Pae W.E. Management of left ventricular distension during peripheral extracorporeal membrane oxygenation for cardiogenic shock. Perfusion. 2012; 27 (4): 326–331.
12. Beurtheret S., Mordant P., Pavie A., Leprince P. Impella and extracorporeal membrane oxygenation: a deman- ding combination. ASAIO J. 2012; 58 (3): 291–293.
13. Dahdouh Z., Roule V., Lognoné T., Sabatier R., Grol- lier G. Percutaneous blade and balloon atrioseptostomy as a supplement to extracorporeal membrane oxyge- nation as a bridge to heart transplantation. Cardiovasc. Revasc. Med. 2012; 13 (1): 69–71.
14. JohnstonT.A.,JaggersJ.,McGovernJ.J.,O'LaughlinM.P. Bedside transseptal balloon dilation atrial septostomy for decompression of the left heart during extracorporeal membrane oxygenation. Catheter Cardiovasc. Interv. 1999; 46: 197–199.
15. BarboneaА.,MalvindiaP.G.,FerrarabP.andTarelliaG. Left ventricle unloading by percutaneous pigtail during extracorporeal membrane oxygenation. Interactive Car- diovasc. and Thorac. Surgery. 2011; 13: 293–295.
16. Vlasselaers D., Desmet M., Desmet L., Meyns B., Dens J. Ventricular unloading with a miniature axial flow pump in combination with extracorporeal mem- brane oxygenation. Intensive Care Med. 2006 Feb; 32 (2): 329–333.
17. Koeckert M.S., Jorde U.P., Naka Y., Moses J.W., Takaya- ma H. Impella LP 2.5 for left ventricular unloading du- ring venoarterial extracorporeal membrane oxygenation support. J. Card. Surg. 2011; 26 (6): 666–668.
Review
For citations:
Poptsov V.N., Spirina E.A., Slobodjannik V.V., Zakharevich V.M., Eremeeva O.A., Masiutin S.A. LEFT VENTRICLE UNLOADING BY PERCUTANEOUS TRANSFEMORAL TRANSSEPTAL CANNULATION OF LEFT ATRIUM IN PATIENTS BRIDGED TO HEART TRANSPLANTATION WITH PERIPHERAL VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION. Russian Journal of Transplantology and Artificial Organs. 2013;15(4):70-83. (In Russ.) https://doi.org/10.15825/1995-1191-2013-4-70-83
Views:
1514
Email this article 