What degree of aortic regurgitation should be safely accepted? What about the use of left ventricular venting? I tried to discuss these questions in this brief paper.
Article Aortic regurgitation and extracorporeal membrane oxygenation...
Usually best to put in an LV vent, otherwise LV distension will result in poor chance of recovery and adds little risk. So set up the centrimag and check for AI / LV distension on TEE. If it looks troublesome then vent the LV.
Thank you very much for your answer. I agree with you. Do you have a cut off to avoid l-vad in case of aortic regurgitation? Do you have experience with more than moderate aortic regurgitation? In my experience, ventricular venting may be not enough in case of significant aortic regurgitation.
Thank you very much again
I don't have a huge experience of this but if they have moderate AI then consideration should have been given to fixing this already. If permanent LVAD then the "Park" suture should suffice. If it is temporary LVAD support then venting may suffice- replacing the valve in this setting is possible and may be necessary for successful weaning however it may increase the magnitude of an operation that is already problematic.
If the valve is replaced in the setting of LVAD support, venting is not necessary but be sure that the valve is opening every few cardiac cycles otherwise it will quickly fuse despite anticoagulation- read my report on this:
Ann Thorac Surg. 2014 Feb;97(2):e41-2.
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