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8 results for “Left ventricular unloading”
Raw Data for the article: Atrial Septostomy for Left Ventricular Unloading During Extracorporeal Membrane Oxygenation for Cardiogenic Shock: Animal Model
<p><strong>Objectives: </strong>The aim of this study was to quantify and understand the unloading effect of percutaneous balloon atrial septostomy (BAS) in acute cardiogenic shock (CS) treated with venoarterial (VA) extracorporeal membranous oxygenation (ECMO).</p> <p><strong>Background: </strong>In CS treated with VA ECMO, increased left ventricular (LV) afterload is observed that commonly interferes with myocardial recovery or even promotes further LV deterioration. Several techniques for LV unloading exist, but the optimal strategy and the actual extent of such procedures have not been fully disclosed.</p> <p><strong>Methods: </strong>In a porcine model (n = 11; weight 56 kg [53-58 kg]), CS was induced by coronary artery balloon occlusion (57 minutes [53-64 minutes]). Then, a step-up VA ECMO protocol (40-80 mL/kg/min) was run before and after percutaneous BAS was performed. LV pressure-volume loops and multiple hemoglobin saturation data were evaluated. The Wilcoxon rank sum test was used to assess individual variable differences.</p> <p><strong>Results: </strong>Immediately after BAS while on VA ECMO support, LV work decreased significantly: pressure-volume area, end-diastolic pressure, and stroke volume to ∼78% and end-systolic pressure to ∼86%, while superior vena cava and tissue oximetry did not change. During elevating VA ECMO support (40-80 mL/kg/min) with BAS vs without BAS, we observed 1) significantly less mechanical work increase (122% vs 172%); 2) no end-diastolic volume increase (100% vs 111%); and 3) a considerable increase in end-systolic pressure (134% vs 144%).</p> <p><strong>Conclusions: </strong>In acute CS supported by VA ECMO, atrial septostomy is an effective LV unloading tool. LV pressure is a key component of LV work load, so whenever LV work reduction is a priority, arterial pressure should carefully be titrated low while maintaining organ perfusion.</p>
A Study on the Effects of Left Ventricular Unloading in the Setting of VA ECMO Support
ClinicalTrials.gov study NCT05913622. IPD Sharing: Not stated. Countries: 2. Publications: 8.
Left Ventricular Unloading to Improve Outcome in Cardiogenic Shock Patients on VA-ECMO
ClinicalTrials.gov study NCT05577195. IPD Sharing: NO. Countries: 1. Publications: 1.
Controlled Trial of High-risk Coronary Intervention With Percutaneous Left Ventricular Unloading
ClinicalTrials.gov study NCT05003817. IPD Sharing: UNDECIDED. Countries: 1. Publications: 1.
Early Left Ventricular unLoading by Impella vs Intra-aortic Balloon Pump
ClinicalTrials.gov study NCT06645990. IPD Sharing: UNDECIDED. Countries: 1. Publications: 15.
Use of Mechanical Left ventricuLar Unloading in Complex Higher-risk Indicated Procedures
ClinicalTrials.gov study NCT07380217. IPD Sharing: YES. Countries: 1. Publications: 0.
Cardiac patch treatment alleviates ischemic cardiomyopathy correlated with unloading pathological stretch and reverting Piezo1/2 expression in left ventricular myocardium
GEO Series GSE202228. Rattus norvegicus. 12 samples. Type: Expression profiling by high throughput sequencing.
Influence of left ventricular unloading on pediatric post-cardiotomy veno-arterial extracorporeal life support outcomes
<p>Meani P, Lorusso R, Kowalewski M, Isgrò G, Cazzaniga A, Satriano A, Ascari A, Bernardinetti M, Cotza M, Marchese G, Ciotti E, Kandil H, Di Dedda U, Aloisio T, Varrica A, Giamberti A, Ranucci M. Influence of left ventricular unloading on pediatric post-cardiotomy veno-arterial extracorporeal life support outcomes. Front Cardiovasc Med. 2022 Aug 10;9:970334. doi: 10.3389/fcvm.2022.970334. PMID: 36035925; PMCID: PMC9399613.</p> <p>Abstract</p> <p><strong>Background: </strong>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.</p> <p><strong>Methods: </strong>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.</p> <p><strong>Results: </strong>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; <em>p</em> = 0.037). On the contrary, extracorporeal cardiopulmonary resuscitation decreased the related survival (OR = 0.32, 95% CI 1.09-0.96; <em>p</em> = 0.041). The most common complications were infections (28.8%), neurological injury (26%), and bleeding (25.6%). However, these did not differently occur in venting and no-venting groups.</p> <p><strong>Conclusion: </strong>In pediatric patients with CHD supported with V-A ECLS for post-cardiotomy CS, the LV unloading strategy was associated with increased survival.</p>
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International Brain Laboratory public data
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OpenNeuro
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