Naslov
Left ventricular unloading using a percutaneous paracorporeal
left ventricular assist device – University Hospital Centre Zagreb experience

Autori
Šipuš, Dubravka ; Planinc, Ivo ; Skorić, Boško ; Velagić, Vedran ; Pašalić, Marijan ; Jurin, Hrvoje ; Lovrić, Daniel ; Samardžić, Jure ; Ljubas Maček, Jana ; Gašparović, Hrvoje ; Biočina, Bojan ; Miličić, Davor ; Čikeš, Maja

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Cardiologia Croatica, 16 (2021), 1-2 / - , 2021, 31-32

Skup
13. kongres Hrvatskoga kardiološkog društva s međunarodnim sudjelovanjem

Mjesto i datum
Online, 10.12.2020. - 24.01.2021

Vrsta sudjelovanja
Poster

Vrsta recenzije
Domaća recenzija

Ključne riječi
cardiogenic shock ; extracorporeal membrane oxygenation ; ProtekSolo ; left ventricular unloading

Sažetak
Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used in refractory cardiogenic shock and cardiac arrest but is characterized by increased left ventricular (LV) afterload and consequent development of pulmonary oedema (ECMO lungs). The ProtekSoloTM (LivaNova, IT) cannula is inserted via the right femoral vein to the left atrium, by a trans-septal puncture (under the guidance of transesophageal echocardiography and fluoroscopy). This bypasses the LV by draining blood from the left atrium to a paracorporeal pump (eg Rotaflow pump (Maquet, DE)) and returning it via a femoral artery cannula, thus providing direct unloading of LV.1-3 We aimed to demonstrate our experience with the paracorporeal LV assist device using the ProtekSolo cannula and Rotaflow pump (PSp-LVAD). Patients and Methods: 7 adult patients underwent PSp-LVAD placement in UHC Zagreb from January to December 2020. We divided the patients in two groups: those who required PSp-LVAD to treat ECMO lungs (n=4) and those who received PSp-LVAD implantation prior to developing ECMO lungs (n=3). In addition to the description of the treated patients, we also assessed 30-day all-cause mortality. Results: The baseline characteristics of patients are shown in Table 1. All patients were male, mean age 56±9.3 years. 57.1% of patients underwent PSp-LVAD placement due to worsening of chronic heart failure and 42.9% due to acute coronary syndrome. Concurrent infection was present in 57.1% of patients. 71.4% were first on VA-ECMO support, of those 80% developed ECMO lungs. Laboratory tests (Figure 1) show improvement in kidney and liver function after PSp-LVAD placement. Outcomes are shown in Table 2 ; patients in prophylactic group have lower observed 30-day mortality rate (33% vs 75%) and longer VA-ECMO support duration due to lower mortality. Besides 2 patients who are still in active treatment, all others died during initial hospitalization due to infective complications, predominantly those that had a concurrent infection upon institution of the PSp-LVAD. Conclusion: Pulmonary edema (ECMO lungs) due to increased LV afterload is a major complication of VA-ECMO. Prophylactic LV unloading by PSp-LVAD seems associated with lower 30-days mortality.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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