Venous-Left Atrial Extracorporeal Membrane Oxygenation Configuration Use in Right Ventricular Failure and Tricuspid Ring

Ravipati, Harish; Sabouni, Mouhamed Amr; Kodavaluru, Tejasri; Alkhawam, Hassan; Ahmed, Mustafa I.

doi:10.1016/j.jaccas.2022.07.020

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…Although the RA to LA transseptal ECMO improved the cardiac output and RV hemodynamics, the patient progressed to multiorgan failure secondary to sepsis. 15 Both cases demonstrated that transseptal ECMO can be achieved percutaneously and that it relieves RVF. We are working on a protocol to enroll lung transplant candidates with PH-RVF into a prospective trial of transseptal ECMO with the ProtekSolo cannula as a bridge to lung transplant.…”

Section: Discussionmentioning

confidence: 92%

“…13 There are 2 case reports of using transseptal ECMO with flow into the LA using the ProtekSolo cannula (LivaNova). 14,15 After a massive pulmonary embolism, a patient had a failing RV and was placed on transseptal ECMO for 8 days. 14 Although the circuit provided effective systemic oxygenation and hemodynamic support, the embolus was sarcoma from metastatic disease, and support was withdrawn.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Transseptal Extracorporeal Membrane Oxygenation to Rescue a Failing Right Ventricle in an Animal Model

Castillo-Larios,

Pollak,

Chaudhary

et al. 2023

Innovations�(Phila)

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Objective: We tested the feasibility and effectiveness of a percutaneous atrial transseptal extracorporeal membrane oxygenation (ECMO) cannulation strategy in a right ventricular failure (RVF) model. Methods: We performed 4 nonsurvival porcine experiments. Percutaneous transseptal access was achieved using a steerable introducer. For guidance, we used fluoroscopy, transesophageal echocardiogram (TEE), and intracardiac echocardiography (ICE). A ProtekDuo rapid deployment cannula (LivaNova, London, UK) was advanced across the septum into the left atrium by 2 to 3 cm. Pulmonary hypertension (PH) was induced by partially clamping the pulmonary artery. ECMO flow was cycled from high (2 to 3 L/min) to low (0.2 to 0.3 L/min) over 2 to 3 hours. Results: Transseptal access using TEE and fluoroscopy was successful in 1 animal and unsuccessful in 1 animal. ICE provided optimal visualization for the remaining 2 animals. Mean arterial pressure (MAP) was associated immediately and consistently with high versus low ECMO flow rate (mean difference: 29 ± 3.1 mm Hg, P = 0.004) but was not restored to baseline values. RV pressure values were dynamic. Given time to equilibrate, mean RV pressure was restored to a baseline level. Conclusions: Percutaneous right atrium to left atrium transseptal cannulation relieved PH-RVF. MAP was restored to a viable level, and mean RV pressure was restored to a baseline level. Transseptal ECMO shows promise as a cannulation strategy to bridge patients with PH-RVF to lung transplant.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Percutaneous Transseptal Extracorporeal Membrane Oxygenation to Rescue a Failing Right Ventricle in an Animal Model

Castillo-Larios,

Pollak,

Chaudhary

et al. 2023

Innovations�(Phila)

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A comparative study of femoral artery and combined femoral and axillary artery cannulation in veno-arterial extracorporeal membrane oxygenation patients

Jin,

Pang,

Song

et al. 2024

Front. Cardiovasc. Med.

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ObjectiveVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a critical support technique for cardiac surgery patients. This study compares the outcomes of femoral artery cannulation vs. combined femoral and axillary artery cannulation in post-cardiotomy VA-ECMO patients. This study aimed to compare the clinical outcomes of critically ill patients post-cardiac surgery under VA-ECMO support using different cannulation strategies. Specifically, the focus was on the impact of femoral artery (FA) cannulation vs. combined femoral artery and axillary artery (FA+AA) cannulation on patient outcomes.MethodsThrough a retrospective analysis, we compared 51 adult patients who underwent cardiac surgery and received VA-ECMO support based on the cannulation strategy employed—FA cannulation in 27 cases vs. FA+AA cannulation in 24 cases.ResultsThe FA+AA group showed significant advantages over the FA group in terms of the incidence of chronic renal failure (CRF) (37.50% vs. 14.81%, p = 0.045), preoperative blood filtration requirement (37.50% vs. 11.11%, p = 0.016), decreased platelet count (82.67 ± 44.95 vs. 147.33 ± 108.79, p = 0.014), and elevated creatinine (Cr) levels (151.80 ± 60.73 vs. 110.26 ± 57.99, p = 0.041), although the two groups had similar 30-day mortality rates (FA group 40.74%, FA+AA group 33.33%). These findings underscore that a combined approach may offer more effective hemodynamic support and better clinical outcomes when selecting an ECMO cannulation strategy.ConclusionDespite the FA+AA group patients presenting with more preoperative risk factors, this group has exhibited lower rates of complications and faster recovery during ECMO treatment. While there has been no significant difference in 30-day mortality rates between the two cannulation strategies, the FA+AA approach may be more effective in reducing complications and improving limb ischemia. These findings highlight the importance of individualized treatment strategies and meticulous monitoring in managing post-cardiac surgery ECMO patients.

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Venous-Left Atrial Extracorporeal Membrane Oxygenation Configuration Use in Right Ventricular Failure and Tricuspid Ring

Cited by 2 publications

References 4 publications

Percutaneous Transseptal Extracorporeal Membrane Oxygenation to Rescue a Failing Right Ventricle in an Animal Model

Percutaneous Transseptal Extracorporeal Membrane Oxygenation to Rescue a Failing Right Ventricle in an Animal Model

A comparative study of femoral artery and combined femoral and axillary artery cannulation in veno-arterial extracorporeal membrane oxygenation patients

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