title: Left atrial decompression during venoarterial extracorporeal membrane oxygenation for left ventricular failure in children: current strategy and clinical outcomes.
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.
authors.affiliation: Divisions of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kotani
authors.forename: Devin
authors.initials: D
authors.lastname: Chetan
authors.forename: Warren
authors.initials: W
authors.lastname: Rodrigues
authors.forename: V Ben
authors.initials: VB
authors.lastname: Sivarajan
authors.forename: Colleen
authors.initials: C
authors.lastname: Gruenwald
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Guerguerian
authors.forename: Glen S
authors.initials: GS
authors.lastname: Van Arsdell
authors.forename: Osami
authors.initials: O
authors.lastname: Honjo
mesh_terms: D054087:Atrial Septum / Q000601:surgery; D002404:Catheterization / Q000379:methods; D019299:Decompression, Surgical; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000601:surgery*