초록접수 현황
| 16F-125 | 구연 발표 |
Left Heart Decompression in Venoarterial Extracorporeal Life Support: Experience between 2014 and 2016
Hongsun Kim, MD, PhD, Yang Hyun Cho, MD, PhD, Kiick Sung, MD, PhD, Ji-Hyuk Yang, MD, PhD, Tae-Gook Jun, MD, PhD, Pyo Won Park, MD, PhD, Young Tak Lee, MD, PhD, Wook Sung Kim, MD, PhD, Dong Seop Jeong, MD, PhD
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background : Left ventricular distension is a serious complication of venoarterial (VA) extracorporeal life support (ECLS). Left heart decompression (LHD) is mandatory to improve survival. However, there are only few studies on the outcome of LDH.
Methods : We reviewed patients who had VA ECLS between January 2014 and July 2016 at Samsung Medical Center. Indication of LHD was either therapeutic or prophylactic. The primary outcome was hospital death.
Results : There were 286 VA ECLS cases for 274 patients. The mean age was 49.52±21.25 years and 181(63.3%) cases were male. There were 37 of LHD procedure. In LHD group, the mean age was 42.59±20.04 years (vs 50.55±21.27 years in non-LHD group, p=0.033), and 22(59.5%) cases were male. Seventeen (45.9%) cases of LHD were performed by percutaneous fluoroscopic guidance including 16 of interatrial septostomy and one of transaortic approach. There were 20 (54.1%) surgical LHD procedures. The drain catheter was inserted through right superior pulmonary vein in 14 and through left ventricular apex in 6. In 25 (67.6%) cases, LHD was performed at the time of ECLS initiation for prophylactic purpose. There were 4/37(10.8%) cases of complication related to the LHD procedure including cardiac injury (n=2), catheter occlusion (n=1), and postoperative bleeding requiring reoperation (n=1). The mean ECLS duration was 21.09±25.59 days in LHD group and 22.62±89.6 days in non-LHD group (p=0.918). There were 17(45.9%) cases of heart transplantation in LHD group, and 6 (2.4%) cases in non-LHD group (p<0.05). In-hospital mortality was 30.6% in LHD group, and 47.5% in non-LHD group (p=0.057).
Conclusion : In our institution, LHD procedure has been often performed for prophylaxis of left ventricular distension with low procedural risk. Surgical LHD was usually reserved for failed interatrial septostomy and central ECLS.
Methods : We reviewed patients who had VA ECLS between January 2014 and July 2016 at Samsung Medical Center. Indication of LHD was either therapeutic or prophylactic. The primary outcome was hospital death.
Results : There were 286 VA ECLS cases for 274 patients. The mean age was 49.52±21.25 years and 181(63.3%) cases were male. There were 37 of LHD procedure. In LHD group, the mean age was 42.59±20.04 years (vs 50.55±21.27 years in non-LHD group, p=0.033), and 22(59.5%) cases were male. Seventeen (45.9%) cases of LHD were performed by percutaneous fluoroscopic guidance including 16 of interatrial septostomy and one of transaortic approach. There were 20 (54.1%) surgical LHD procedures. The drain catheter was inserted through right superior pulmonary vein in 14 and through left ventricular apex in 6. In 25 (67.6%) cases, LHD was performed at the time of ECLS initiation for prophylactic purpose. There were 4/37(10.8%) cases of complication related to the LHD procedure including cardiac injury (n=2), catheter occlusion (n=1), and postoperative bleeding requiring reoperation (n=1). The mean ECLS duration was 21.09±25.59 days in LHD group and 22.62±89.6 days in non-LHD group (p=0.918). There were 17(45.9%) cases of heart transplantation in LHD group, and 6 (2.4%) cases in non-LHD group (p<0.05). In-hospital mortality was 30.6% in LHD group, and 47.5% in non-LHD group (p=0.057).
Conclusion : In our institution, LHD procedure has been often performed for prophylaxis of left ventricular distension with low procedural risk. Surgical LHD was usually reserved for failed interatrial septostomy and central ECLS.
책임저자: Yang Hyun Cho
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
발표자: Hongsun Kim, E-mail : yoursunny@gmail.com