Peripheral extracorporeal membrane oxygenation (ECMO) setting remains a valid option to treat cardiogenic shock (CS). We investigated a percutaneous approach to unload the left ventricle (LV) while on veno-arterial (v-a) peripheral ECMO support. Between 2017 and 2018, eight patients (three females, mean age: 49.6 years old, and five males, mean age: 58 years old, respectively) suffered refractory CS due to acute myocardial infarction (n = 4), acute myocarditis (n = 2), acute decompensation on chronic heart failure (n = 1), and primary graft failure after heart transplantation (Htx) (n = 1), respectively. After a multidisciplinary CS team discussion, it was decided to proceed with peripheral v-a ECMO placement and percutaneous LV venting via right internal jugular vein access to drain the pulmonary artery (PA), in the hybrid operating room. In a single postcardiotomy case, the PA trunk was vented centrally. Mean ECMO support time was 8.5 days. Seven (87.5%) patients were successfully weaned from ECMO and one (12.5%) successfully bridged to Htx. All patients were successfully discharged after treatment except for a single case who died due to sepsis. In case of not recommended usage of LV apical venting, the adoption of v-a peripheral ECMO support associated with percutaneous PA drainage enables the rapid onset of extracorporeal life support with an effective biventricular unloading.
From the *Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
†Department of Anesthesiology, S. Orsola Hospital, Bologna University, Bologna, Italy
‡Department of Cardiology, S. Orsola Hospital, Bologna University, Bologna, Italy.
Submitted for consideration September 2018; accepted for publication in revised form January 2019.
Disclosure: The authors have no conflicts of interest to report.
Correspondence: Dr. Antonio Loforte, Cardiothoracic Surgeon, Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Via Massarenti n.9, 40138 Bologna, Italy. Email: email@example.com.