Influence of left ventricular unloading on pediatric post-cardiotomy veno-arterial extracorporeal life support outcomes.

Background

The effectiveness of veno-arterial extracorporeal life support (V-A ECLS) in treating neonatal and pediatric patients with complex congenital heart disease (CHD) and requiring cardio-circulatory assistance is well-known. Nevertheless, the influence of left ventricle (LV) distension and its countermeasure, namely LV unloading, on survival and clinical outcomes in neonates and children treated with V-A ECLS needs still to be addressed. Therefore, the aim of this study was to determine the effects of LV unloading on in-hospital survival and complications in neonates and children treated with V-A ECLS.

Methods

The clinical outcomes of 90 pediatric patients with CHD under 16 years of age supported with V-A ECLS for post-cardiotomy cardiogenic shock (CS) were retrospectively reviewed in relationship with the presence or absence of an active LV unloading strategy.

Results

The patient cohort included 90 patients (age 19.6 ± 31.54 months, 64.4% males), 42 of whom were vented with different techniques (38 with atrial septostomy (AS) or left atria cannula, two with cannula from LV apex, 1 with intra-aortic balloon pump (IABP), and one with pigtail across the aortic valve). The LV unloading strategy significantly increased the in-hospital survival (odds ratio [OR] = 2.74, 95% CI 1.06-7.08;

Conclusion

In pediatric patients with CHD supported with V-A ECLS for post-cardiotomy CS, the LV unloading strategy was associated with increased survival.

Informations de copyright

Copyright © 2022 Meani, Lorusso, Kowalewski, Isgrò, Cazzaniga, Satriano, Ascari, Bernardinetti, Cotza, Marchese, Ciotti, Kandil, Di Dedda, Aloisio, Varrica, Giamberti and Ranucci.

Déclaration de conflit d'intérêts

Author RL was consultant for Medtronic, Getinge, and LivaNova and member of the Advisory Board for Eurosets and Xenios. Author MR received spekaer's honoraria, consultancy fees, and research grants from: Haemonetics Werfen-IL Haemosonics Roche Diagnostics CSL Behring Livanova Medtronic. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.