{
  "abstract": "Background: Peripheral venoarterial (VA)–extracorporeal membrane oxygenation (ECMO) increases left ventricular (LV) afterload, and therefore the risk of LV distension, pulmonary edema, and cardiac stasis. Balloon atrial septostomy (BAS) provides atrial-level unloading, but the durability of LV venting remains uncertain.\n\nObjectives: This study aimed to evaluate the clinical effectiveness of BAS for LV venting in patients requiring peripheral VA-ECMO for cardiogenic shock (CS).\n\nMethods: The authors conducted a retrospective study of consecutive adults with CS supported with peripheral VA-ECMO who underwent BAS for LV unloading at an academic center (2019-2024). The primary endpoint was LV venting failure, a composite of pulmonary edema, LV distension, spontaneous echocardiographic contrast, LV or aortic root thrombus, stroke due to ECMO, or escalation to additional mechanical support.\n\nResults: A total of 28 patients were included in the study. BAS resulted in a significant reduction in mean left atrial pressure (20.5-13.5 mm Hg; P < 0.001). Durable LV venting was achieved in a subset of patients; however, LV venting failure occurred in 53.6%, driven primarily by pulmonary edema. Pulse-pressure trajectories differed according to eventual LV venting-failure status (interaction P = 0.018). Model-estimated pulse pressure was higher at 48 hours (P = 0.010) and 72 hours (P = 0.031) among patients who ultimately did not experience venting failure.\n\nConclusions: Among patients receiving peripheral VA-ECMO for CS, BAS achieves atrial-level decompression and may provide durable LV venting in select patients, although venting failure remains common. Observed arterial pulse-pressure trajectories differed according to eventual LV venting failure status.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.",
    "Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.",
    "Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.",
    "Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.",
    "Department of Anesthesia, Vanderbilt University Medical Center, Nashville, Tennessee, USA.",
    "Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.",
    "Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: Aniket.Rali@vumc.org."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Arjun B Kapoor"
    },
    {
      "affs": [
        1
      ],
      "name": "Joy Stouffer"
    },
    {
      "affs": [
        0
      ],
      "name": "Dhruv Sarma"
    },
    {
      "affs": [
        0
      ],
      "name": "Nanda Nayak"
    },
    {
      "affs": [
        0
      ],
      "name": "Parth Visrodia"
    },
    {
      "affs": [
        2
      ],
      "name": "Brandon Petree"
    },
    {
      "affs": [
        3
      ],
      "name": "Enock Adjei",
      "orcid": "0009-0006-3896-6224"
    },
    {
      "affs": [
        3
      ],
      "name": "Amir Teimouri Dereshgi"
    },
    {
      "affs": [
        1
      ],
      "name": "Emily N Hollis"
    },
    {
      "affs": [
        0
      ],
      "name": "Jared O'Leary"
    },
    {
      "affs": [
        4
      ],
      "name": "Bret Alvis"
    },
    {
      "affs": [
        3
      ],
      "name": "Aaron Williams"
    },
    {
      "affs": [
        5
      ],
      "name": "Matthew Bacchetta"
    },
    {
      "affs": [
        6
      ],
      "name": "Aniket S Rali"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/167wyz6m4rpqp.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jacadv.2026.103344",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13696345/",
  "id": "167wyz6m4rpqp",
  "issns": [
    "2772-963X"
  ],
  "landing_url": "https://doi.org/10.1016/j.jacadv.2026.103344",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2204|Mechanical Circulatory Support Devices"
    ]
  ],
  "openalex": "W7222841357",
  "pdf_url": "https://europepmc.org/articles/PMC13696345?pdf=render",
  "pmcid": "PMC13696345",
  "pmid": "42887462",
  "published": "2026-10-16",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/167wyz6m4rpqp.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:43Z",
      "native_id": "PMC13696345",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.jacadv.2026.103344"
    },
    {
      "first_seen": "2026-10-30T12:18:46Z",
      "native_id": "MED:42887462",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42887462"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:2705|Cardiac Valve Diseases and Treatments",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Atrial Septostomy and Left Ventricular Venting During Peripheral VA-ECMO",
  "title_text": "Atrial Septostomy and Left Ventricular Venting During Peripheral VA-ECMO",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:33:42Z",
  "url": "https://research.draconitic.com/paper/167wyz6m4rpqp",
  "venue": "JACC: Advances",
  "versions": []
}