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Extracorporeal life support with an integrated left ventricular vent in children with a low cardiac output
Stany Sandrio1, Wolfgang Springer2, Matthias Karck1
11Department of Cardiac Surgery,University of Heidelberg,Heidelberg,Germany.
Insights
Central extracorporeal life support with a left ventricular vent effectively decompresses the left heart in pediatric cardiac failure patients. This approach promotes myocardial recovery and improves outcomes in critically ill children.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Pediatric cardiac failure presents significant management challenges.
- Extracorporeal life support (ECLS) is a vital intervention for severe cases.
- Optimizing left ventricular unloading during ECLS is crucial for myocardial recovery.
Purpose of the Study:
- To evaluate the efficacy and safety of central ECLS integrated with a left ventricular (LV) vent.
- To assess the impact of LV decompression on myocardial recovery in pediatric patients.
- To determine the feasibility of this approach in children with cardiac failure.
Main Methods:
- Eight pediatric patients received central ECLS with an integrated LV vent.
- Cannulation involved the ascending aorta and right atrium.
- The LV vent was inserted via the right superior pulmonary vein to achieve active left heart decompression.
Main Results:
- Seven out of eight patients were successfully weaned from ECLS.
- One patient required transition to a biventricular assist device.
- No intra-cardiac thrombus, embolic stroke, or significant intracranial bleeding was observed.
- Median support duration was 6 days (range 5-10 days).
Conclusions:
- Integrated LV venting during central ECLS can prevent left heart distension and aid myocardial recovery.
- Separate blood gas analysis can detect coronary hypoxia during myocardial recovery.
- Central ECLS with an integrated LV vent is recommended for children with intractable cardiac failure.
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.
