经皮球囊房间隔造口术联合静脉-动脉体外膜肺氧合可安全有效地减轻左心负荷。
Percutaneous balloon atrial septostomy on top of venoarterial extracorporeal membrane oxygenation results in safe and effective left heart decompression.
机构信息
1 Department of Paediatric Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust, Imperial College London, London, UK.
2 Cardiology Clinical Academic Group, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK.
出版信息
Eur Heart J Acute Cardiovasc Care. 2018 Feb;7(1):70-79. doi: 10.1177/2048872616675485. Epub 2016 Oct 14.
BACKGROUND
Transcatheter techniques are emerging for left atrial (LA) decompression under venoarterial extracorporeal membrane oxygenation (VA-ECMO). We aimed to assess whether balloon atrioseptostomy (BAS) is a safe and efficient strategy.
METHODS
All patients who underwent percutaneous static BAS under VA-ECMO at four tertiary institutions were retrospectively reviewed.
RESULTS
From 2000 to 2014, BAS was performed in 64 patients (32 adults and 32 children). Indications for ECMO support included acute myocarditis (31.3%) and non-myocarditis cardiac disease, mostly end-stage dilated cardiomyopathy (32.8%). BAS was required because of pulmonary oedema/haemorrhage and left ventricular (LV) distension. The mean balloon diameter was 21.8 ± 8.4mm. Adequate LA decompression was achieved in all patients. Mean LA pressure fell from 24.2 ± 6.9 mmHg to 7.8 ± 2.6 mmHg ( p < 0.001). The left-to-right atrial pressure gradient fell from 17.2 ± 7.1 mmHg to 0.09 ± 0.5 mmHg ( p < 0.001). Echocardiography showed an unrestrictive left-to-right atrial shunting in all patients. Improvement of day 1 chest X-ray was observed in 76.6% of patients, clinical status in 98.4% of patients and pulmonary haemorrhage in 14 out of 14 patients. Complications occurred in 9.4% of patients, representing pericardial effusion, fast atrial fibrillation, ventricular fibrillation requiring defibrillation, transient complete heart block and femoral venous dissection requiring covered stent placement. In the 37 (57.8%) patients who were successfully decannulated, the median ECMO duration was 9 (range: 4-24) days. After a median follow-up of 12.3 (range: 0.1-142) months, 35.9% patients died, 17.2% received a LV assist device as a bridge to transplantation, 31.2% were transplanted and 56.2% were home discharged and alive.
CONCLUSIONS
Percutaneous BAS may be a safe and efficient strategy for discharging the LA in both adults and children supported by VA-ECMO.
背景
在体外膜肺氧合（VA-ECMO）下，经导管技术正被用于左心房（LA）减压。我们旨在评估球囊房间隔造口术（BAS）是否是一种安全有效的策略。
方法
回顾性分析了在四家三级医院接受经皮静态 BAS 的所有患者。
结果
2000 年至 2014 年间，64 例患者（32 例成人和 32 例儿童）接受了 BAS。ECMO 支持的指征包括急性心肌炎（31.3%）和非心肌炎性心脏病，主要是终末期扩张型心肌病（32.8%）。由于肺水肿/出血和左心室（LV）扩张，需要进行 BAS。球囊直径平均为 21.8±8.4mm。所有患者均实现了充分的 LA 减压。LA 压力从 24.2±6.9mmHg 降至 7.8±2.6mmHg（p<0.001）。左房至右房压力梯度从 17.2±7.1mmHg 降至 0.09±0.5mmHg（p<0.001）。所有患者的超声心动图均显示左向右无限制分流。76.6%的患者第 1 天的胸片改善，98.4%的患者临床状态改善，14 例患者中有 14 例肺出血改善。9.4%的患者发生并发症，包括心包积液、快速心房颤动、需要除颤的心室颤动、短暂性完全性心脏阻滞和需要放置带膜支架的股静脉夹层。在 37 例（57.8%）成功拔管的患者中，ECMO 持续时间中位数为 9（范围：4-24）天。中位随访 12.3（范围：0.1-142）个月后，35.9%的患者死亡，17.2%的患者接受左心室辅助装置作为移植桥接，31.2%的患者接受移植，56.2%的患者出院回家并存活。
结论
经皮 BAS 可能是一种安全有效的策略，可用于 VA-ECMO 支持的成人和儿童的 LA 减压。
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