Percutaneous balloon atrial septostomy on top of venoarterial extracorporeal membrane oxygenation results in safe and effective left heart decompression. Issue 1 (February 2018)

• Record Type: Journal Article
• Authors: Baruteau, Alban-Elouen; Barnetche, Thomas; Morin, Luc; Jalal, Zakaria; Boscamp, Nicholas S; Le Bret, Emmanuel; Thambo, Jean-Benoit; Vincent, Julie A; Fraisse, Alain; Torres, Alejandro J
• Is Part Of: European heart journal. Volume 7:Issue 1(2018)
• Page Start: 70
• Page End: 79
• Publication Date: 2018-02
• Subjects: ECMO support -- transcatheter techniques -- cardiogenic shock -- haemodynamics -- pulmonary oedema -- outcomes; 616.1205
• DOI: 10.1177/2048872616675485
• Languages: English
• ISSNs: 2048-8726

Abstract

Background: Transcatheter techniques are emerging for left atrial (LA) decompression under venoarterial extracorporeal membrane oxygenation (VA-ECMO). We aimed to assess whether balloon atrioseptostomy (BAS) is a safe and efficient strategy. Methods: All patients who underwent percutaneous static BAS under VA-ECMO at four tertiary institutions were retrospectively reviewed. Results: From 2000 to 2014, BAS was performed in 64 patients (32 adults and 32 children). Indications for ECMO support included acute myocarditis (31.3%) and non-myocarditis cardiac disease, mostly end-stage dilated cardiomyopathy (32.8%). BAS was required because of pulmonary oedema/haemorrhage and left ventricular (LV) distension. The mean balloon diameter was 21.8 ± 8.4mm. Adequate LA decompression was achieved in all patients. Mean LA pressure fell from 24.2 ± 6.9 mmHg to 7.8 ± 2.6 mmHg ( p < 0.001). The left-to-right atrial pressure gradient fell from 17.2 ± 7.1 mmHg to 0.09 ± 0.5 mmHg ( p < 0.001). Echocardiography showed an unrestrictive left-to-right atrial shunting in all patients. Improvement of day 1 chest X-ray was observed in 76.6% of patients, clinical status in 98.4% of patients and pulmonary haemorrhage in 14 out of 14 patients. Complications occurred in 9.4% of patients, representing pericardial effusion, fast atrial fibrillation, ventricular fibrillation requiring defibrillation, transient complete heart block and femoral venous dissection requiring covered stent placement. In the 37 (57.8%) patients who were successfully decannulated, the median ECMO duration was 9 (range: 4–24) days. After a median follow-up of 12.3 (range: 0.1–142) months, 35.9% patients died, 17.2% received a LV assist device as a bridge to transplantation, 31.2% were transplanted and 56.2% were home discharged and alive. Conclusions: Percutaneous BAS may be a safe and efficient strategy for discharging the LA in both adults and children supported by VA-ECMO.