Left ventricular venting through the right subclavian artery access during peripheral extracorporeal life support

Abstract

The use of peripheral extracorporeal life support during refractory cardiac arrest sometimes exposes the patient to left ventricular dilatation requiring venting. We report here a simple technique for LV venting by a cannula inserted through right subclavian artery and positioned in the left ventricle.

Percutaneous Decompression of the Left Ventricle in Cardiogenic Shock Patients on Venoarterial Extracorporeal Membrane Oxygenation

“…Surgical decompression of the LV is generally achieved via a large cannula placed into the LV or the right upper pulmonary vein via a sternotomy or minithoracotomy . Due to the significant morbidity associated with these surgical techniques, several percutaneous alternatives were developed . These methods include placing a simple ‘venting’ catheter with multiple side holes into the LV, incorporating a large bore cannula (placed in the LV or in the pulmonary artery) into the ECMO circuit, or combing ECMO support with percutaneous left ventricular assist devices (pLVAD) such as Impella and TandemHeart.…”

Successful Left-Heart Decompression during Extracorporeal Membrane Oxygenation in an Adult Patient by Percutaneous Transaortic Catheter Venting

“…Dilatation of the LV may occur due to several factors: (1) the afterload induced by VA ECMO in cases of LV failure, (2) suboptimal venous return accompanying right heart recovery, (3) heavy collateral bronchial flow, and (4) aortic insufficiency [ 2 ]. The importance of left heart decompression during VA ECMO is generally recognized, but percutaneous drainage of the left heart is rarely reported and no consensus exists regarding the timing of LV decompression during VA ECMO.…”

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“…In those cases, the need for intervention for left ventricular decompression must be considered. [4][5][6][7] Management of ventricular distention can be through conservative, pharmaceutic (inotropic agents, diuretics), interventional, or surgical ways. Interventional modalities for LVD include intraaortic balloon pump (to increase coronary perfusion, improve contractility, and reduce afterload), atrial septostomy, trans-septal left atrial drain, or other devices such as the Impella (Abiomed, Danvers, MA, USA).…”