Mohammed AlGhamdi , Gabriel Saiydoun , Guillaume Lebreton , Jean-Philippe Mazzucotelli
{"title":"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","authors":"Mohammed AlGhamdi , Gabriel Saiydoun , Guillaume Lebreton , Jean-Philippe Mazzucotelli","doi":"10.1016/j.ahjo.2025.100542","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> < 0.001). Weaning from VA-ECMO with LV discharge was achieved successfully in 126 (64 %) patients, with 60 (30.5 %) in recovery (<em>P</em> = 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 (<em>P</em> = 0.250). After LV unloading in patients receiving VA-ECMO, 60 (30.5 %) experienced early mortality (<em>P</em> = 0.286).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"54 ","pages":"Article 100542"},"PeriodicalIF":1.3000,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Percutaneous atrial septostomy for left ventricular unloading in patients on peripheral venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis\",\"authors\":\"Mohammed AlGhamdi , Gabriel Saiydoun , Guillaume Lebreton , Jean-Philippe Mazzucotelli\",\"doi\":\"10.1016/j.ahjo.2025.100542\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> < 0.001). Weaning from VA-ECMO with LV discharge was achieved successfully in 126 (64 %) patients, with 60 (30.5 %) in recovery (<em>P</em> = 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 (<em>P</em> = 0.250). After LV unloading in patients receiving VA-ECMO, 60 (30.5 %) experienced early mortality (<em>P</em> = 0.286).</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":72158,\"journal\":{\"name\":\"American heart journal plus : cardiology research and practice\",\"volume\":\"54 \",\"pages\":\"Article 100542\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-04-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American heart journal plus : cardiology research and practice\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S266660222500045X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American heart journal plus : cardiology research and practice","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S266660222500045X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Percutaneous atrial septostomy for left ventricular unloading in patients on peripheral venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis
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.