{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:28:25Z","timestamp":1791462505364,"version":"4.3.4"},"reference-count":67,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":268,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Veno-arterial extracorporeal life support (VA ECLS) is crucial for neonatal and paediatric patients with severe circulatory collapse but may cause left ventricular (LV) overload, affecting myocardial recovery and causing complications. Evidence on optimal LV decompression strategies in paediatric patients remains limited. We conducted a systematic review following PRISMA guidelines, including articles published between 1993 and 2024 focused on VA ECLS and LV decompression in patients under 18 years of age. The review included 11 retrospective cohorts and registry-based studies (2012\u20132024), totalling 1222 paediatric patients undergoing decompression. Patient demographics, initial diagnoses and VA ECLS settings were heterogeneous. The prevalence of LV decompression ranged from 46.6% in post-cardiotomy to 10.5% in non-post-cardiotomy peripheral VA ECLS cases. Most patients (57.1%) were supported with peripheral VA ECLS, and the majority (57.4%) underwent percutaneous decompression, whereas surgical approaches predominated in post-cardiotomy central VA ECLS. Balloon atrial septostomy (BAS) was the most frequent technique (50%), followed by surgically placed left atrial cannula (37.4%). Thirteen case series (70 patients) and 28 case reports (28 patients) were also reviewed. Substantial variability in LV decompression strategies exists based on age and clinical scenario. PAS-based techniques were more common in younger patients on peripheral VA ECLS while older children often underwent different strategies. Surgical approaches were preferred in central VA ECLS, particularly in the post-cardiotomy setting. Procedural safety varied by technique. While PAS-based strategies such as BAS generally showed low complication rates, adverse events like arrhythmia, bleeding and cardiac perforation were reported in 7%\u20139% of cases. Surgical LA cannulation was associated with higher bleeding risk. Impella use was linked to haemolysis (50%) and major bleeding (20%). Comparative data highlight that each technique carries distinct procedural risks and complication profiles. In conclusion, LV decompression during paediatric VA ECLS remains technically challenging and variably adopted. Its benefit appears more consistent in the post-cardiotomy setting, where improved survival and reduced adverse outcomes were observed. Given the lack of standardization, further prospective studies and collaborative registries are essential to guide strategy selection, timing and risk\u2013benefit balance, particularly in such a vulnerable population.<\/jats:p>","DOI":"10.1002\/ehf2.15325","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T03:55:31Z","timestamp":1748231731000},"page":"2711-2725","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Left Ventricular Decompression in Paediatric Veno-Arterial Extracorporeal Life Support: Reviewing the Evidence"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6257-729X","authenticated-orcid":false,"given":"Giacomo","family":"Veronese","sequence":"first","affiliation":[{"name":"Pediatric Intensive Care Unit, ASST Papa Giovanni XXIII , Bergamo ,","place":["Italy"]},{"name":"Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Meani","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht ,","place":["The Netherlands"]},{"name":"Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Sirico","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua , Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Di Salvo","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua , Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Ammirati","sequence":"additional","affiliation":[{"name":"De Gasperis Cardio Center, Niguarda Hospital , Milan ,","place":["Italy"]},{"name":"School of Medicine and Surgery, University of Milan-Bicocca , Monza ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Varrica","sequence":"additional","affiliation":[{"name":"Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Di Dedda","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Bianchi","sequence":"additional","affiliation":[{"name":"Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London , London ,","place":["UK"]},{"name":"Unit of Cardiovascular Anesthesia and Intensive Care, Azienda Ospedaliera Sant'Anna e San Sebastiano , Caserta ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Isgr\u00f2","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Giamberti","sequence":"additional","affiliation":[{"name":"Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Aloisio","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Dickstein","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Anesthesia, Columbia University Medical Center , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezio","family":"Bonanomi","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, ASST Papa Giovanni XXIII , Bergamo ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahaaldin","family":"Alsoufi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery, University of Louisville , Louisville, Kentucky ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi R.","family":"Thiagarajan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peta M.A.","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Michael","family":"McMullan","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Seattle Children Hospital , Seattle, Washington ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan P.","family":"Barbaro","sequence":"additional","affiliation":[{"name":"Division of Critical Care, C.S. Mott Children's Hospital, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graeme","family":"MacLaren","sequence":"additional","affiliation":[{"name":"Cardiothoracic Intensive Care Unit, National University Hospital \u00a0","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Ranucci","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navin K.","family":"Kapur","sequence":"additional","affiliation":[{"name":"The Cardiovascular Center, Tufts Medical Center , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Lorusso","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic 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