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Left Ventricular Venting in VA-ECMO: A Propensity-Score Matched Analysis
Session:
Sessão de Comunicações Orais 04 – A bomba em falência: fronteiras hemodinâmicas e metabólicas na doença cardíaca crítica
Speaker:
Rita Barbosa Sousa
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.3 Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Barbosa Sousa; Márcia Presume; Catarina Santos-Jorge; Joana Certo Pereira; Rita Almeida Carvalho; Débora da Silva Correia; Samuel Azevedo; Ana Rita Bello; João Presume; Jorge Ferreira; Catarina Brízido
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Introduction: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to restore systemic perfusion in cardiogenic shock (CS), but the retrograde aortic flow may increase left ventricular afterload and potentially impair myocardial recovery. The use of venting strategies may minimize this impact. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Aim: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">This study aims to assess if left ventricular unloading during VA-ECMO support is associated with lower mortality.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Methods: </span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Single-center retrospective study including 107 consecutive patients with CS undergoing VA-ECMO from 2016 to 2025. Exclusion criterion was left ventricular ejection fraction (LVEF) </span><span style="font-family:Symbol">></span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">40%.</span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> A propensity score (PS) was used to match venting and no venting population in a 1:1 fashion according to age, sex, acute myocardial infarction (AMI) aetiology, LVEF, SCAI and cardiac arrest before VA-ECMO. Primary endpoint was 180-day mortality.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Results: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">The PS yielded two groups of 38 patients each </span></span><span style="font-size:11.0pt"><span style="font-family:Symbol">[</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">mean age 51±15 years, 80% (n=61) male, 37% (n=28) with AMI-CS, 51% (n=39) with previous cardiac arrest and 37% (n=28) in SCAI E</span></span><span style="font-size:11.0pt"><span style="font-family:Symbol">]</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">, well balanced for baseline characteristics. Among patients in the venting group, 87% (n=33) were unloaded with an intra-aortic balloon pump (IABP), 8% (n=3) with transseptal left atrial cannulation and 5% (n=2) with an Impella device.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (68% vs 37%, p=0.004) and 180-day mortality (76% vs 45%, p=0.002). In multivariate analyses, older age was significantly associated with a higher mortality risk (HR 1.046, 95% CI 1.00–1.09, p = 0.030), whereas venting was independently associated with improved survival (HR 0.18, 95% CI 0.06–0.56, p = 0.003).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#071320">Although bacteraemia was more frequent in the venting group </span></span></span><span style="font-size:11.0pt"><span style="font-family:Symbol">[</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#071320">11% (n=4) vs 40% (n=15), p=0.005)</span></span></span><span style="font-size:11.0pt"><span style="font-family:Symbol">]</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">, r<span style="color:#071320">ates of clinically significant haemorrhage, pulmonary infection, and limb ischemia were similar between groups. Moreover, there were also no significant differences in the need for invasive mechanical ventilation or renal replacement therapy.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">In this cohort of VA-ECMO patients with LVEF<40%, left ventricular unloading, primarily with IABP support, was associated with lower 180-day mortality.</span></span></span></span></p>
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