Table 6.
Comparative studies
| Venting mode | Authors | Year | Trial Type | Trial demograhics | VA-ECMO-Indication | Venting Technique | Timing of venting initiation | Mechanical support duration | Follow-up time | Hemodynamic effect of decompression | Mortality outcome | Additional outcome information | Complications/adverse events |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Surgical trans-apical LV venting vs. IABP vs. percutaneous atrial balloon septostomy | Hasde et al. [85] | 2021 | Singlecenter, retrospective (Enrollment period 2015–2020) | n = 448, mean age: 55.8 years, 61.1% male, rate of decompression in total study population: 11.8% (n = 16 trans-apical LV Vent, n = 20 IABP, n = 17 percutaneous atrial balloon septostomy) | AMI: 14.1%; acute cardiac decompensation: 33.1%; PCS: 28.1%; other: 24.7% [total study population] | Left thoracotomy, trans-apical insertion of a 19-21Fr cannula into LV; average venting flow 600–1800 ml/min (trans-apical LV Vent group); transfemoral insertion of a IABP (Maquet) into safe zone (IABP group); transvenous transseptal puncture and balloon dilatation (balloon septostomy group) | Mean interval from VA-ECMO to LV decompression: 52.1 h (trans-apical LV Vent), 13.9 h (IABP), 46.1 h (balloon septostomy) | Median duration of VA-ECMO: 16 days (trans-apical LV Vent), 16 days (IABP), 16 days (balloon septostomy) | No infor-mation | PCWP reduction after decompression: -17.2 mmHg (trans-apical LV Vent), -3.9 mmHg (IABP), -9.6 mmHg (balloon septostomy); sysPAP reduction after decompression: -20.3 mmHg (trans-apical LV Vent), -4.1 mmHg (IABP), -10.4 mmHg (balloon septostomy); CVP reduction after decompression: -7.4 mmHg (trans-apical LV Vent), -1.6 mmHg (IABP), -1.3 mmHg (balloon septostomy); LA diameter reduction after decompression: -14.8 mm (trans-apical LV Vent), -2.9 mm (IABP), -5.1 mm (balloon septostomy) | In-hospital mortaliy rate: 56.3% (trans-apical LV Vent), 45% (IABP), 47.1% (balloon septostomy) | Bridge to durable LVAD or heart transplantation: 25% (trans-apical LV Vent), 40% (IABP), 35.3% (balloon septostomy) | Access site bleeding: 18.8% (trans-apical LV Vent), 0% (IABP), 5.9% (balloon septostomy); device malpositioning: 12.5% (trans-apical LV Vent), 5% (IABP), 0% (balloon septostomy); vascular complications: 0% (trans-apical LV Vent), 5% (IABP), 0% (balloon septostomy); ventricular arrhythmias: 12.5% (trans-apical LV Vent), 0% (IABP), 5.9% (balloon septostomy); neurological complications: 12.6% (trans-apical LV Vent), 0% (IABP), 5.9% (balloon septostomy) |
| Impella vs. IABP | Piechura et al. [86] | 2020 | Singlecenter, retrospective (Enrollment period 2015–2019) | n = 63, mean age: 52 years (reactive venting group), 60 years (immediate venting group) (p = 0.0255), 66 years (Impella group), 55 years (IABP group) (p = 0.0013), 77% (reactive), 67% (immediate) male, rate of decompression in total study population: 100% | AMI: 40% (reactive), 36% (immediate); ischemic cardiomyopathy: 3% (reactive), 9% (immediate); non-ischemic cardiomyopathy: 23% (reactive), 15% (immediate); myocarditis: 3% (reactive), 12% (immediate); PCS: 17% (reactive), 18% (immediate); post-transplant graft dysfunction: 13% (reactive), 9% (immediate); eCPR at VA-ECMO initiation: 33% (reactive), 15% (immediate) (p = 0.091) | Impella CP: n = 19; percutaneous insertion of IABP: n = 16; no further information on other venting modalities | Simultaneous with VA-ECMO initiation: 74% (Impella), 63% (IABP); unloading first: 21% (Impella), 31% (IABP); VA-ECMO first: 5% (Impella), 6% (IABP) | Mean duration of VA-ECMO: 4.97 days (reactive), 6.55 days (immediate) (p = 0.215); mean duration of mechanical support: 5.45 days (reactive), 8.45 days (immediate) (p = 0.087), 9.89 days (Impella), 6.81 days (IABP) (p = 0.24) | No infor-mation | No information | 30-day mortality rate: 67% (reactive), 58% (immediate) (p = 0.458), 53% (Impella), 69% (IABP) (p = 0.49) | Need for additional LV vent: 0% (Impella), 25% (IABP) (p = 0.035); no patient with PCS recieved Impella; Impella more often used for patients with ischemic cardiomyopathy | Bleeding: 79% (Impella), 56% (IABP) (p = 0.15); intracranial hemorrhage: 11% (Impella), 0% (IABP) (p = 0.49); hemolysis: 26% (Impella), 19% (IABP) (p = 0.7); vascular complication: 21% (Impella), 19% (IABP) (p = 1.0); ischemic stroke: 26% (Impella), 13% (IABP) (p = 0.415); renal replacement therapy: 47% (Impella), 44% (IABP) (p = 0.83); sepsis: 16% (Impella), 13% (IABP) (p = 1.0); mesenteric ischemia: 5% (Impella), 6% (IABP) (p = 1.0); abdominal compartment syndrome: 0% (Impella), 6% (IABP) (p = 0.46); intracardiac thrombus: 32% (Impella), 19% (IABP) (p = 0.46) |
| Combined evaluation of IABP with or without surgical LV venting | Bonacchi et al. [75] | 2020 | Multicenter, prospective (Enrollment period 2004–2018) | n = 209, mean age: 67.5 years, 69.9% male, rate of decompression using IABP in total study population: 100%, rate of surgical LV decompression in total study population: 74.2% | PCS: 100% | Percutaneous insertion of IABP in 100%, pre-operative insertion of IABP: 27.8%; of all patients who received a surgical LV venting, trans-apical cannulation was performed in 50.3%, and trans-pulmonary cannulation in 49.7% | No information | Mean duration of VA-ECMO: 5.3 days | 38 months | No information | Overall 1-year mortality rate: 67.9%; overall 5-year mortality rate: 74.8%; intra-operative IABP insertion (OR 0.6, p = 0.038) and trans-apical LV venting (OR 0.6, p = 0.03) predictors of early mortality | Overall weaninge rate: 58.3%; pre-operative IABP insertion: 86.3% (in-hospital survivors), 72.7% (non-survivors) (p = 0.018) | Bleeding requiring re-thoracotomy: 36.4%; leg ischemia: 6.5%; stroke: 11.4%; GI-complications: 16.2% [overall cohort] |
| Impella vs. Mixed surgical venting techniques (PA, left atrium, left ventricle) | Tepper et al. [87] | 2017 | Singlecenter, retrospective (Enrollment period 2010–2016) | n = 45, median age: 58 years (n = 23, ECMELLA group), 56 years (n = 22, surgical Vent group), 74% (ECMELLA), 59% (surgical Vent) male | AMI: 39%; non-ischemic cardiomyopathy: 30%; PCS: 13%; ischemic cardiomyopathy: 13%; Myocarditis: 4% | Impella 2.5: 30%; Impella CP: 30%; Impella 5.0: 39%, surgical implantation of an LV venting cannula through the LV apex, right superior pulmonary vein, or pulmonary artery | Impella as first device: 60.9%; VA-ECMO as first device: 39.1% [ECMELLA group] | No information | 30 days | Improvement of pulmonary edema 48 h after decompression: 65% (ECMELLA), 24% (surgical Vent); diastolic PAP: 23.3 mmHg (before ECMELLA), 15.6 mmHg (48 h after ECMELLA) (p = 0.02), 20.1 mmHg (before surgical Vent), 15.6 mmHg (48 h after surgical Vent) (p = 0.01); CVP: 12.4 mmHg (before ECMELLA), 9.7 mmHg (48 h after ECMELLA) (p = 0.02); ALT: 560 U/l (before ECMELLA), 280 U/l (48 h after ECMELLA) (p = 0.002) | 48 h-survival rate: 87% (ECMELLA), 95% (surgical Vent) (p = 0.61); 30-day survival rate: 43% (ECMELLA), 32% (surgical Vent) (p = 0.42) | VA-ECMO decannulation rate: 30% (ECMELLA), 27% (surgical Vent); transition to durable LVAD: 26% (ECMELLA), 18% (surgical Vent); ICU discharge rate: 35% (ECMELLA), 23% (surgical Vent) | Bleeding: 39% (ECMELLA, attributed to Impella in n = 5 cases), 45% (surgical Vent) (p = 0.67); hemolysis: 22% (ECMELLA), 5% (surgical Vent) (p = 0.19); hypoperfusion/limb ischemia: 13% (ECMELLA, non attributed to Impella), 18% (surgical Vent) (p = 0.70) |
VA-ECMO, venoarterial extracorporeal membrane oxygenation; IABP, intra-aortic balloon pump; AMI, acute myocardial infarction; PCS, postcardiotomy shock; eCPR, extracorporeal cardiopulmonary resuscitation; LA, left atrium; LV, left ventricle; PCWP, pulmonary capillary wedge pressure; PAP, pulmonary arterial pressure; CVP, central venous pressure; ALT, alanine aminotransferase; LVAD, left ventricular assist device; GI, gastrointestinal; ICU, intensive care unit; OR, odds ratio