Left atrial decompression during venoarterial extracorporeal membrane oxygenation for left ventricular failure in children: current strategy and clinical outcomes

Artif Organs. 2013 Jan;37(1):29-36. doi: 10.1111/j.1525-1594.2012.01534.x. Epub 2012 Sep 30.

Abstract

From 2005 to 2011, 23 of 178 (12.9%) patients with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) had left atrial (LA) decompression to help improve left ventricular (LV) function, LA/LV dilatation, and/or lung edema. LA decompression was achieved with LA cannulation (n = 16), surgically created adjustable atrial septal defect (n = 3), or balloon atrial septostomy (n = 4). Sixteen (70%) patients had LA decompression at the time of ECMO initiation and all had LA decompression within 12 hours of ECMO initiation. ECMO duration was 5.9 ± 4.5 days and 16 (70%) patients were successfully decannulated. Subsequent intensive care unit and hospital survival was achieved in 13 (57%) and 12 (52%) patients, respectively. Earlier timing of LA decompression appeared to be associated with a high probability of weaning from ECMO and reasonable LV functional recovery.

MeSH terms

  • Atrial Septum / surgery
  • Catheterization / methods
  • Decompression, Surgical
  • Echocardiography
  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • Heart Atria / surgery*
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant
  • Male
  • Postoperative Complications
  • Retrospective Studies
  • Statistics, Nonparametric
  • Treatment Outcome
  • Ventricular Dysfunction, Left / surgery*