title: Initial Experience of Transaortic Catheter Venting in Patients with Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock.
abstract: Extracorporeal membrane oxygenation (ECMO) has become one of the often applied mechanical support for acute cardiogenic shock. During venoarterial (VA) ECMO support, left heart decompression should be considered when left ventricular (LV) distension develops with pulmonary edema and LV dysfunction. The aim of this study was to report the results of transaortic catheter venting (TACV), as an alternative venting method, performed during VA-ECMO in patients with acute cardiogenic shock. We retrospectively reviewed the records of seven patients who underwent both ECMO and TACV between February 2013 and February 2014. Extracorporeal membrane oxygenation was performed uneventfully, and TACV was introduced under transthoracic echocardiographic guidance in all cases. Hemodynamic parameters, LV ejection fraction, and LV end-diastolic dimension (LVEDD) were measured 24 hours after initiating TACV in survivors. There were no procedure-related complications. Four of the seven patients (58%) survived. Transaortic catheter venting led to an increase in mean blood pressure in all patients (p = 0.050). There was a significant difference between pre- and post-TACV-LVEDD (59 ± 14 vs. 50 ± 12 mm, p = 0.044), with a 10-23% reduction in LVEDD in survivors. Transaortic catheter venting might be an acceptable alternative to venting procedures and useful for LV recovery during VA-ECMO in patients with severe LV dysfunction.
authors.affiliation: From the *Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; †Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea; ‡Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea; §Department of Thoracic and Cardiovascular Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea and ¶Present address: Department of Thoracic and Cardiovascular Surgery, Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea.
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Hong
authors.forename: Joung Hun
authors.initials: JH
authors.lastname: Byun
authors.forename: Hee Moon
authors.initials: HM
authors.lastname: Lee
authors.forename: Yong Hwan
authors.initials: YH
authors.lastname: Kim
authors.forename: Gu-Hyun
authors.initials: GH
authors.lastname: Kang
authors.forename: Ju Hyeon
authors.initials: JH
authors.lastname: Oh
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Hwang
authors.forename: Han Yong
authors.initials: HY
authors.lastname: Kim
authors.forename: Jae Hong
authors.initials: JH
authors.lastname: Park
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Jung
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000150:complications / Q000628:therapy*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000601:surgery*; D055815:Young Adult