Open Direct Beating-Heart Atrioseptostomy: Left Heart Unloading Under Extracorporeal Life Support

The venoarterial extracorporeal life support often requires venting the left ventricle to treat or prevent pulmonary edema. In postcardiotomy patients requiring extracorporeal life support before the patient closure, the best option to unload the left cavities remains unclear. Indeed, one may add a vent in a pulmonary vein, or in the pulmonary artery or through the left ventricle apex. All these surgical options will require a second sternotomy for removal and expose the patient to infection and bleeding. Herein, we present a venting technic through an atrioseptostomy performed on a beating heart, in the operating room, under transesophageal echocardiography guidance. The result is effective, rapid, inexpensive, and simple to unload the left ventricle.