Outcomes of left ventricular unloading with a transseptal cannula during extracorporeal membrane oxygenation in adults

Abstract

We evaluated the benefit of left ventricular (LV) unloading using a percutaneous transseptal left atrial (LA) drain catheter via femoral vein incorporated into the ECMO venous circuit. This single-center retrospective observational study analyzed clinical outcomes of the LA venting group (N=62) who underwent percutaneous transseptal LA drain placement comparing with the conventionally treated control group (N=62) with an arterial pulse pressure below 10mm Hg for at least 24hours from December 2012 to August 2018. The ECMO weaning rate (61.3% vs. 38.7%, P=.012) and cardiac transplantation rate (29.0% vs. 11.3%, P=.014) were higher in the LA venting group than in the control group. Inhospital mortality was not significantly different (56.5% vs. 69.4%, P=.191). Pulmonary congestion mostly improved after LA decompression (61.3%, P=.003). A serum lactate level at 24hours after LA venting of more than 2.2mmol/L was associated with poor outcomes. LA venting via transseptal cannula reduced pulmonary venous congestion and achieved higher rates of successful ECMO weaning and cardiac transplantation. Placement of a transseptal venous drain cannula should be considered in patients with uncontrolled pulmonary edema secondary to severe LV loading undergoing VA-ECMO.