Extracorporeal life support with an integrated left ventricular vent in children with a low cardiac output

Department of Paediatric Cardiology, University of Heidelberg, Heidelberg, GermanyAbstract Background: The aim of this study was to evaluate our experience in central extracorporeal lifesupport with an integrated left ventricular vent in children with cardiac failure. Methods: Eight childrenacquired extracorporeal life support with a left ventricular vent, either after cardiac surgery (n54) or duringan acute cardiac illness (n54). The ascending aorta and right atrium were cannulated. The left ventricularvent was inserted through the right superior pulmonary vein and connected to the venous line on theextracorporeal life support such that active left heart decompression was achieved. Results: No patient diedwhile on support, seven patients were successfully weaned from it and one patient was transitioned to abiventricular assist device. The median length of support was 6 days (range 5–10 days). One patient diedwhile in the hospital, despite successful weaning from extracorporeal life support. No intra-cardiac thrombusor embolic stroke was observed. No patient developed relevant intracranial bleeding resulting in neurologicaldysfunction during and after extracorporeal life support. Conclusions: In case of a low cardiac output and aninsufficient inter-atrial shunt, additional left ventricular decompression via a vent could help avoid left heartdistension and might promote myocardial recovery. In pulmonary dysfunction, separate blood gas analysesfrom the venous cannula and the left ventricular vent help detect possible coronary hypoxia when the leftventricle begins to recover. We recommend the use of central extracorporeal life support with an integratedleft ventricular vent in children with intractable cardiac failure.