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Transaortic Left Ventricular Unloading in VA-ECMO: The Transsubclavian Route
Nicolas d'Ostrevy1, Adama Sawadogo1, Jean Porterie2
1Department of Cardiac Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France.
The Annals of Thoracic Surgery
|March 18, 2019
Summary
Left ventricular unloading using a transaortic catheter vent effectively managed cardiogenic shock in two patients. This approach successfully supported patients awaiting heart transplantation or recovery from severe illness.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Left ventricular unloading is crucial during extracorporeal life support to mitigate risks associated with elevated afterload.
- Minimizing left ventricular afterload is essential for preserving cardiac function in critically ill patients.
Observation:
- A transaortic catheter vent, inserted via a subclavian approach, was utilized for left ventricular unloading in two distinct patient cases.
- The first patient, a 48-year-old male, presented with refractory cardiogenic shock post-ST-elevation myocardial infarction and severe biventricular dysfunction.
- The second patient, a 56-year-old male, was admitted with severe influenza, indicating a different etiology for critical illness.
Findings:
- The transaortic catheter vent implantation and subsequent unloading procedure were technically successful in both patients.
- Successful left ventricular unloading was achieved, leading to improved hemodynamic stability.
- The intervention served as a successful bridge to definitive therapy in both cases.
Implications:
- Transaortic catheter venting offers a viable strategy for left ventricular unloading in patients requiring extracorporeal life support.
- This technique can serve as a critical bridge to heart transplantation for patients with end-stage heart failure.
- It also provides a pathway to recovery for patients experiencing severe cardiac dysfunction due to other critical illnesses, such as severe influenza.
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