title: Percutaneous Decompression of the Left Ventricle in Cardiogenic Shock Patients on Venoarterial Extracorporeal Membrane Oxygenation.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation is an important therapeutic option for patients with refractory cardiogenic shock. Adequate decompression of the left ventricular in these patients is a key predictor of successful recovery. The currently available percutaneous decompression techniques are limited by their partial unloading capability.
  
  
  METHODS
  We describe a series of four consecutive patients with refractory cardiogenic shock in whom adequate left ventricular decompression was achieved by integrating a transseptally placed left ventricular cannula into the existing extracorporeal membrane oxygenation circuit.
  
  
  RESULTS
  From May to June 2015, four consecutive patients underwent transvenous transseptal left ventricular decompression with a 22 French cannula that was integrated into the extracorporeal membrane oxygenation circuit in a Y fashion. The mean age was 47.5 ± 20 years. All patients had refractory shock, and three patients failed prior decompression with an intra-aortic balloon pump. Fluoroscopy time was 12.15 ± 2.6 minutes. No procedural complications were noted. All patients had significant reduction in their pulmonary capillary wedge pressure and resolution of their pulmonary edema. Two patients died during the hospitalization due to sepsis and/or multiorgan failure.
  
  
  CONCLUSIONS
  Antegrade transseptal left ventricular decompression is feasible in patients on extracorporeal membrane oxygenation and persistent pulmonary edema.
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, University of Rochester, Rochester, New York.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alkhouli
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, University of Rochester, Rochester, New York.|Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, New York.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Narins
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Rochester, Rochester, New York.
authors.forename: Juan
authors.initials: J
authors.lastname: Lehoux
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Rochester, Rochester, New York.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Knight
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, University of Rochester, Rochester, New York.
authors.forename: Bryan
authors.initials: B
authors.lastname: Waits
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, University of Rochester, Rochester, New York.
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Ling
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000628:therapy; D011669:Pulmonary Wedge Pressure; D012770:Shock, Cardiogenic / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult