Percutaneous atrial septostomy for left ventricular unloading in patients on peripheral venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Mohammed AlGhamdi , Gabriel Saiydoun , Guillaume Lebreton , Jean-Philippe Mazzucotelli
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引用次数: 0

Abstract

Background

This study systematically reviewed the safety and efficacy of atrial septostomy as a left ventricular (LV) unloading intervention in paediatric and adult patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO).

Methods

The PubMed, Cochrane, and Google Scholar online databases were searched, and studies describing patients who received VA-ECMO for refractory cardiogenic shock and underwent atrial septostomy for LV unloading were included. Laboratory experiments, animal studies, and patients who received ECMO with a method other than atrial septostomy for LV unloading were excluded.

Results

From the 12 studies analysed, data were collected on 197 patients, including 97 (49 %) males and 75 (38 %) females (data unavailable for 25 patients) with ages ranging from 3.65 days to 70 years. VA-ECMO duration was 1.71 to 40 days (P < 0.001). Weaning from VA-ECMO with LV discharge was achieved successfully in 126 (64 %) patients, with 60 (30.5 %) in recovery (P = 0.006) and 66 (33.5 %) converted to a ventricular assistant device or transplantation. Additionally, 54 (27.4 %) patients experienced unsuccessful weaning. During atrial septostomy for LV unloading, 14 (7.1 %) patients experienced complications, whereas 180 (91.4 %) did not (P = 0.250). After LV unloading in patients receiving VA-ECMO, 60 (30.5 %) experienced early mortality (P = 0.286).

Conclusion

VA-ECMO-assisted percutaneous atrial septostomy is a viable, safe, and successful alternative for LV unloading in both children and adults with refractory cardiogenic shock. However, further studies with larger sample sizes are required to comprehensively assess the morbidity and mortality associated with this approach.

Abstract Image

经皮心房间隔造瘘术治疗外周静脉动脉体外膜氧合患者左心室负荷:系统回顾和荟萃分析
本研究系统回顾了房间隔造口术作为左心室(LV)卸载干预在接受外周静脉动脉体外膜氧合(VA-ECMO)的儿童和成人患者中的安全性和有效性。方法检索PubMed、Cochrane和谷歌Scholar在线数据库,纳入因难治性心源性休克而接受VA-ECMO和因左室减压而行房间隔造口术的患者的研究。排除了实验室实验、动物研究和采用房间隔造口术以外的方法进行ECMO的左室卸压的患者。结果从分析的12项研究中,收集了197例患者的数据,包括97例(49%)男性和75例(38%)女性(25例患者无法获得数据),年龄从3.65天到70岁不等。VA-ECMO持续时间为1.71 ~ 40天(P <;0.001)。126例(64%)患者成功脱离VA-ECMO并左室放电,60例(30.5%)患者恢复(P = 0.006), 66例(33.5%)患者转为心室辅助装置或移植。此外,54例(27.4%)患者脱机失败。在房间隔造口术中,14例(7.1%)患者出现并发症,180例(91.4%)患者没有出现并发症(P = 0.250)。接受VA-ECMO的患者左室卸荷后,60例(30.5%)出现早期死亡(P = 0.286)。结论va - ecmo辅助经皮房间隔造口术是治疗顽固性心源性休克的一种可行、安全、成功的方法。然而,需要更大样本量的进一步研究来全面评估与这种方法相关的发病率和死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.60
自引率
0.00%
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审稿时长
59 days
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