Percutaneous pulmonary artery venting via jugular vein while on peripheral extracorporeal membrane oxygenation running: a less invasive approach to provide full biventricular unloading

A delicate concern while on peripheral veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) therapy is the retrograde flow in the aorta towards the left ventricle (LV), with increase of LV afterload (1-5). The consequent LV pressure overload may account for LV dilatation, increase in left atrial (LA) pressure and pulmonary edema. Furthermore, LV overload increases the wall stress, thus negative influencing the process of myocardial function recovery. If the overload is extreme and LV contractile impairment significant, the aortic valve may remain closed permanently, causing blood stasis and predisposing thrombi formation in the left heart chambers. In this manuscript, we describe our institutional approach for LV decompression while on peripheral ECMO running by percutaneously venting the pulmonary artery (PA) trunk