Protracted aortic valve closure during peripheral veno-arterial extracorporeal life support: is intra-aortic balloon pump an effective solution?

Paolo Meani, Thijs Delnoij, Giuseppe M. Raffa, Nuccia Morici, Giovanna Viola, Alice Sacco, Fabrizio Oliva, Sam Heuts, Jan Willem Sels, Rob Driessen, Paul Roekaerts, Martijn Gilbers, Elham Bidar, Rick Schreurs, Ehsan Natour, Leo Veenstra, Suzanne Kats, Jos Maessen, Roberto Lorusso

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Left ventricular (LV) afterload increase with protracted aortic valve (AV) closure may represent a complication of veno-arterial extracorporeal membrane oxygenation (V-A ECMO). The aim of the present study was to assess the effects of an intra-aortic balloon pump (IABP) to overcome such a hemodynamic shortcoming in patients submitted to peripheral V-A ECMO. Methods: Among 184 adult patients who were treated with peripheral V-A ECMO support at Medical University Center Maastricht Hospital between 2007 and 2018, patients submitted to IABP implant for protracted AV closure after V-A ECMO implant were retrospectively identified. All clinical and hemodynamic data, including echocardiographic monitoring, were collected and analyzed. Results: During the study period, 10 subjects (mean age 60 years old, 80% males) underwent IABP implant after peripheral V-A ECMO positioning due to the diagnosis of protracted AV closure and inefficient LV unloading as assessed by echocardiography and an absence of pulsation in the arterial pressure wave. Recovery of blood pressure pulsatility and enhanced LV unloading were observed in 8 patients after IABP placement, with no significant differences in the main hemodynamic parameters, inotropic therapy or in the ECMO flow (p=0.48). The weaning rate in this patient subgroup (mean ECMO duration 8 days), however, was only 10%, with another patient finally transplanted, leading to a 20% survival-to-hospital discharge. Conclusion: IABP placement was an effective solution in order to reverse the protracted AV closure and impaired LV unloading observed during peripheral V-A ECMO support. However, the impact on the weaning rate and survival needs further investigations.

Original languageEnglish
Pages (from-to)35-41
Number of pages7
JournalPerfusion (United Kingdom)
Volume34
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

Keywords

  • ECMO
  • extracorporeal life support
  • intra-aortic balloon
  • LV unloading

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Safety Research
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

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