Abstract 15403: Percutaneous Atrioseptostomy is a Safe and Efficient Strategy for Left Heart Discharge Under Veno-Arterial Peripheral Extracorporeal Membrane Oxygenation
Background: Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a life-saving mechanical support in case of intractable heart failure. It is widely used in both children and adult patients, as a bridge to recovery or heart transplantation. It can lead to increased left atrial pressure, resulting in haemoptysis and severe acute pulmonary oedema.
We assessed the hypothesis that percutaneous atrioseptostomy is a safe and efficient alternative for left heart discharge under VA-ECMO.
Methods and Results: A monocenter retrospective study was conducted at our tertiary center. From April 2008 to April 2013, 160 patients were assisted with peripheral VA-ECMO. Twenty-three of them (1 month to 72 years old, median age: 34 years, 6 children and 17 adults) needed left heart discharge and had a percutaneous atrioseptostomy. The procedure was done in the catheterization laboratory under fluoroscopic guidance via the femoral vein and a transseptal puncture using a Brockenbrough needle. For adult patients, a 28 mm Inoue balloon was inflated across the inter-atrial septum, creating an unrestrictive 30 mm atrial septal defect. Left and right atrial pressures were measured in the cath lab before and just after atrioseptostomy.
Intractable heart failure was due to acute myocarditis (n=5), dilated cardiomyopathy (n=9), acute coronary syndrome (n=4) or post-operative myocardial dysfunction (n=5). Atrioseptostomy was performed under local anaesthesia in 9 patients (40%). Median delay from ECMO to atrioseptostomy was 64 hours (4 to 766 hours). No procedure-related complication was reported. Left atrial pressure significantly decreased after atrioseptostomy, from 22mmHg (5 to 45 mmHg) to 10mmHg (1 to 19 mmHg), p<0,001. Clinical improvement was observed in 4 of 6 patients with pulmonary haemorrhage and 18 of 22 patients with pulmonary oedema (81,8%, IC95%[65.7%-97.9%]). At a mean follow-up of 8.3 ± 9,2 days after the procedure, two patients were successfully weaned from ECMO, 4 patients had implantation of a left ventricular assist device, 8 were transplanted and 9 patients died under VA-ECMO.
Conclusion: Percutaneous atrioseptostomy is a safe and efficient strategy to discharge the left heart in paediatric and adult patients under peripheral VA-ECMO.
- Extracorporeal circulation
- Atrial septal defect
- Pulmonary edema
- Pediatric cardiac intensive care
- Heart catheterization
- © 2013 by American Heart Association, Inc.