Raw Data for the article: Atrial Septostomy for Left Ventricular Unloading During Extracorporeal Membrane Oxygenation for Cardiogenic Shock: Animal Model

<strong>Objectives: </strong>The aim of this study was to quantify and understand the unloading effect of percutaneous balloon atrial septostomy (BAS) in acute cardiogenic shock (CS) treated with venoarterial (VA) extracorporeal membranous oxygenation (ECMO). <strong>Background: </strong>In CS treated with VA ECMO, increased left ventricular (LV) afterload is observed that commonly interferes with myocardial recovery or even promotes further LV deterioration. Several techniques for LV unloading exist, but the optimal strategy and the actual extent of such procedures have not been fully disclosed. <strong>Methods: </strong>In a porcine model (n = 11; weight 56 kg [53-58 kg]), CS was induced by coronary artery balloon occlusion (57 minutes [53-64 minutes]). Then, a step-up VA ECMO protocol (40-80 mL/kg/min) was run before and after percutaneous BAS was performed. LV pressure-volume loops and multiple hemoglobin saturation data were evaluated. The Wilcoxon rank sum test was used to assess individual variable differences. <strong>Results: </strong>Immediately after BAS while on VA ECMO support, LV work decreased significantly: pressure-volume area, end-diastolic pressure, and stroke volume to ∼78% and end-systolic pressure to ∼86%, while superior vena cava and tissue oximetry did not change. During elevating VA ECMO support (40-80 mL/kg/min) with BAS vs without BAS, we observed 1) significantly less mechanical work increase (122% vs 172%); 2) no end-diastolic volume increase (100% vs 111%); and 3) a considerable increase in end-systolic pressure (134% vs 144%). <strong>Conclusions: </strong>In acute CS supported by VA ECMO, atrial septostomy is an effective LV unloading tool. LV pressure is a key component of LV work load, so whenever LV work reduction is a priority, arterial pressure should carefully be titrated low while maintaining organ perfusion.<strong>研究目的：</strong>本研究旨在量化并阐明经皮球囊房间隔造口术（percutaneous balloon atrial septostomy, BAS）在接受静脉-动脉体外膜肺氧合（venoarterial extracorporeal membranous oxygenation, VA ECMO）支持的急性心源性休克（acute cardiogenic shock, CS）中的左心室卸载效应。<strong>研究背景：</strong>在接受VA ECMO支持的CS患者中，常观察到左心室（left ventricular, LV）后负荷升高，这会干扰心肌恢复，甚至加剧左心室功能恶化。目前虽已有多种左心室卸载技术，但最优策略及此类操作的实际获益程度尚未完全明确。<strong>研究方法：</strong>本实验采用猪模型（n=11；体重56kg[53-58kg]），通过冠状动脉球囊阻断诱导急性CS，阻断时长为57分钟[53-64分钟]。在实施BAS前后，分别执行阶梯式VA ECMO支持方案（流量范围40-80mL/kg/min），并对左心室压力-容积环及多项血红蛋白饱和度数据进行评估。采用Wilcoxon秩和检验分析单个变量的组间差异。<strong>研究结果：</strong>在VA ECMO支持下完成BAS后即刻，左心室做功显著降低：压力-容积面积、舒张末期压力及每搏量均降至约78%，收缩末期压力降至约86%，而上腔静脉血氧饱和度与组织血氧饱和度无明显变化。在提升VA ECMO支持流量（40-80mL/kg/min）的过程中，与未实施BAS相比，实施BAS时出现以下变化：1）机械做功增幅显著降低（122% vs 172%）；2）舒张末期容积无明显增加（100% vs 111%）；3）收缩末期压力出现显著升高（134% vs 144%）。<strong>研究结论：</strong>在VA ECMO支持的急性CS患者中，房间隔造口术是一种有效的左心室卸载手段。左心室压力是左心室负荷的关键组成部分，因此当以降低左心室做功为首要目标时，应在维持器官灌注的前提下，谨慎地将动脉压力滴定调低。