Percutaneous left atrial decompression in adults with refractory cardiogenic shock supported with veno-arterial extracorporeal membrane oxygenation
Percutaneous left atrial decompression in adults with refractory cardiogenic shock supported with veno-arterial extracorporeal membrane oxygenation
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DOI：
10.1111/jocs.13146
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发表时间：
2017-06-01
影响因子：
1.6
通讯作者：
Billia, Filio
中科院分区：
文献类型：
--
作者：
Alhussein, Mosaad;Osten, Mark;Billia, Filio
研究背景和目的：左室（LV）扩张是顽固性心源性休克患者接受静脉-动脉体外膜氧合（VA-ECMO）治疗时公认的并发症，可导致肺水肿、心肌耗氧量增加和左室血栓形成。房间隔造口术作为左室扩张的一种治疗策略。方法：72例VA-ECMO患者中，7例经房间隔入路行房间隔造口术。房间隔造口术的主要适应症是难治性肺水肿。结果：从ECMO开始到LA减压平均时间为1.3天（范围0-2天）。手术成功率100%，肺水肿得到改善。5例患者存活出院，1例双心室功能恢复，2例移植，1例脱管，1例过渡到长期耐用心室辅助装置。两名患者死亡，一名多器官功能衰竭，另一名严重缺氧脑损伤。结论：房间隔造口术是一种有效的左室减压方法，操作安全，成功率高。
Background and Aim of the Study: Left ventricular (LV) distention, a recognized complication in patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock, can lead to pulmonary edema, increased myocardial oxygen consumption, and LV thrombus formation. Atrial septostomy was examined as a management strategy for LV distension.Methods: Of 72 patients supported with VA-ECMO, seven patients underwent atrial septostomy through a trans-septal approach. The primary indication for atrial septostomy was refractory pulmonary edema.Results: The mean time from ECMO initiation to LA decompression was 1.3 days (range 0-2 days). There was a 100% procedural success rate with improvement in pulmonary edema. Five patients survived to discharge with one patient exhibiting recovery of biventricular function, two patients were transplanted, one patient was decannulated, and one patient was transitioned to long-term durable ventricular assist device. Two patients died, one from multi-organ failure and one with severe anoxic brain injury.Conclusion: Atrial septostomy is an effective method of LV decompression that can be performed safely with a high success rate.