Left Ventricular Unloading With an IABP in Patients Undergoing Ventricular Tachycardia Ablation With ECMO Support.
J Cardiothorac Vasc Anesth
; 35(9): 2686-2693, 2021 09.
Article
em En
| MEDLINE
| ID: mdl-33487532
ABSTRACT
OBJECTIVE:
The authors investigated the preprocedural predictors of postprocedural intra-aortic balloon pump (IABP) need in patients undergoing transcatheter ventricular tachycardia (VT) ablation on venoarterial (VA) extracorporeal membrane oxygenation (ECMO).DESIGN:
Observational study.SETTING:
Hybrid operating room and intensive care unit of a teaching hospital. PATIENTS Participants were 121 consecutive patients with unstable VT undergoing transcatheter ablation with VA-ECMO.INTERVENTIONS:
In patients with postprocedural echocardiographic, radiographic, or hemodynamic signs of increased left ventricle afterload, an IABP was positioned. MEASUREMENTS AND MAINRESULTS:
Patients in the IABP group were more frequently on angiotensin-converting enzyme inhibitors (58% v 37%; pâ¯=â¯0.03) and had lower median baseline ejection fraction (25% v 28% pâ¯=â¯0.05), larger end-diastolic diameter (69.7 mm ± 13.0 v 65.7 mm ± 11.3; pâ¯=â¯0.03), and more frequent ischemic etiology as the reason for dilated cardiomyopathy (76% v 47%; pâ¯=â¯0.04,) when compared with patients not requiring IABP. Postoperatively, the IABP group required longer mechanical ventilation (24 hours [20-56.5] v 23 hours [15-28]; pâ¯=â¯0.003), intensive care unit stay (78 hours [46-174] v 48 hours [24-72]; p < 0.001), and continuous renal replacement therapy (13.3% v 1.3%; pâ¯=â¯0.006). By multivariate analysis, end-diastolic diameter (odds ratio [OR]1.08; confidence interval [CI] 1.00-1.16; pâ¯=â¯0.049), ischemic dilated cardiomyopathy (OR 8.40; CI 2.15-32.88; pâ¯=â¯0.002), and more-than-moderate mitral regurgitation (OR 4.83; CI 1.22-19.22; pâ¯=â¯0.025) were independent predictors of need for IABP.CONCLUSIONS:
The need for an IABP to unload the left ventricle can be predicted by ventricular size, medium-severe mitral valvular defect, and ischemic etiology of the dilated cardiomyopathy.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Oxigenação por Membrana Extracorpórea
/
Coração Auxiliar
/
Taquicardia Ventricular
Tipo de estudo:
Observational_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article