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Extracorporeal life support with an integrated left ventricular vent in children with a low cardiac output*

Published online by Cambridge University Press:  06 August 2013

Stany Sandrio ,
Wolfgang Springer ,
Matthias Karck ,
Matthias Gorenflo ,
Alexander Weymann ,
Arjang Ruhparwar  and
Tsvetomir Loukanov
Stany Sandrio*
Affiliation:
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Wolfgang Springer
Affiliation:
Department of Paediatric Cardiology, University of Heidelberg, Heidelberg, Germany
Matthias Karck
Affiliation:
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Matthias Gorenflo
Affiliation:
Department of Paediatric Cardiology, University of Heidelberg, Heidelberg, Germany
Alexander Weymann
Affiliation:
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Arjang Ruhparwar
Affiliation:
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Tsvetomir Loukanov
Affiliation:
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
*
Correspondence to: S. Sandrio, MD, Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Tel: +49 6221 56 37981; Fax: +49 6221 56 5585; E-mail: [email protected]; [email protected]
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Abstract

Background: The aim of this study was to evaluate our experience in central extracorporeal life support with an integrated left ventricular vent in children with cardiac failure. Methods: Eight children acquired extracorporeal life support with a left ventricular vent, either after cardiac surgery (n = 4) or during an acute cardiac illness (n = 4). The ascending aorta and right atrium were cannulated. The left ventricular vent was inserted through the right superior pulmonary vein and connected to the venous line on the extracorporeal life support such that active left heart decompression was achieved. Results: No patient died while on support, seven patients were successfully weaned from it and one patient was transitioned to a biventricular assist device. The median length of support was 6 days (range 5–10 days). One patient died while in the hospital, despite successful weaning from extracorporeal life support. No intra-cardiac thrombus or embolic stroke was observed. No patient developed relevant intracranial bleeding resulting in neurological dysfunction during and after extracorporeal life support. Conclusions: In case of a low cardiac output and an insufficient inter-atrial shunt, additional left ventricular decompression via a vent could help avoid left heart distension and might promote myocardial recovery. In pulmonary dysfunction, separate blood gas analyses from the venous cannula and the left ventricular vent help detect possible coronary hypoxia when the left ventricle begins to recover. We recommend the use of central extracorporeal life support with an integrated left ventricular vent in children with intractable cardiac failure.

Keywords

Paediatriccirculatory temporary supportextracorporeal membrane oxygenation.
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 4 , August 2014 , pp. 654 - 660
Copyright
Copyright © Cambridge University Press 2013 

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Footnotes

*

This paper was presented at 46th Annual Meeting of the Association for European Paediatric and Congenital Cardiology, 24 May 2012, Istanbul, Turkey; and 42nd Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, 18 February 2013, Freiburg, Germany.

References

1. Aiyagari, RM, Rocchini, AP, Remenapp, RT, Graziano, JN. Decompression of the left atrium during extracorporeal membrane oxygenation using a transseptal cannula incorporated into the circuit. Crit Care Med 2006; 34: 2603–2606.CrossRefGoogle ScholarPubMed
2. Bavaria, JE, Ratcliffe, MB, Gupta, KB, Wenger, RK, Bogen, DK, Edmunds, LH Jr. Changes in left ventricular systolic wall stress during biventricular circulatory assistance. Ann Thorac Surg 1988; 45: 526–532.CrossRefGoogle ScholarPubMed
3. Kato, J, Seo, T, Ando, H, Takagi, H, Ito, T. Coronary arterial perfusion during venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 1996; 111: 630–636.CrossRefGoogle ScholarPubMed
4. Moubarak, G, Weiss, N, Leprince, P, Luyt, CE. Massive intraventricular thrombus complicating extracorporeal membrane oxygenation support. Can J Cardiol 2008; 24: e1.CrossRefGoogle ScholarPubMed
5. Seib, PM, Faulkner, SC, Erickson, CC, et al. Blade and balloon atrial septostomy for left heart decompression in patients with severe ventricular dysfunction on extracorporeal membrane oxygenation. Catheter Cardiovasc Interv 1999; 46: 179–186.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
6. Secker-Walker, JS, Edmonds, JF, Spratt, EH, Conn, AW. The source of coronary perfusion during partial bypass for extracorporeal membrane oxygenation (ECMO). Ann Thorac Surg 1976; 21: 138–143.CrossRefGoogle ScholarPubMed
7. Hirschl, RB, Heiss, KF, Bartlett, RH. Severe myocardial dysfunction during extracorporeal membrane oxygenation. J Pediatr Surg 1992; 27: 48–53.CrossRefGoogle ScholarPubMed
8. Chaturvedi, RR, Macrae, D, Brown, KL, et al. Cardiac ECMO for biventricular hearts after paediatric open heart surgery. Heart 2004; 90: 545–551.CrossRefGoogle ScholarPubMed
9. Rosenberg, AA, Kinsella, JP. Effect of extracorporeal membrane oxygenation on cerebral hemodynamics in newborn lambs. Crit Care Med 1992; 20: 1575–1581.CrossRefGoogle ScholarPubMed
10. Bulas, D, Glass, P. Neonatal ECMO: neuroimaging and neurodevelopmental outcome. Semin Perinatol 2005; 29: 58–65.CrossRefGoogle ScholarPubMed
11. Leontiadis, E, Koertke, H, Bairaktaris, A, Koerfer, R. Thrombosis of the ascending aorta during mechanical circulatory support in a patient with cardiogenic shock. Interact Cardiovasc Thorac Surg 2010; 11: 510–511.CrossRefGoogle Scholar
12. Foley, PJ, Morris, RJ, Woo, EY, et al. Limb ischemia during femoral cannulation for cardiopulmonary support. J Vasc Surg 2010; 52: 850–853.CrossRefGoogle ScholarPubMed
13. Fumagalli, R, Bombino, M, Borelli, M, et al. Percutaneous bridge to heart transplantation by venoarterial ECMO and transaortic left ventricular venting. Int J Artif Organs 2004; 27: 410–413.CrossRefGoogle ScholarPubMed
14. Barbone, A, Malvindi, PG, Ferrara, P, Tarelli, G. Left ventricle unloading by percutaneous pigtail during extracorporeal membrane oxygenation. Interact Cardiovasc Thorac Surg 2011; 13: 293–295.CrossRefGoogle ScholarPubMed