{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T03:54:39Z","timestamp":1773028479874,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T00:00:00Z","timestamp":1770508800000},"content-version":"vor","delay-in-days":38,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovascular Therapeutics"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Comparisons of preload unloading techniques for left ventricle overdistension during venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support are scarce. We compared outcomes in patients with left ventricular distension treated with cannulated percutaneous atrioseptostomy combined with ECMO\u2014specified as selective biatrial extracorporeal membrane oxygenation (SBA\u2010ECMO)\u2014versus those treated with Impella CP\/5.0 in combination with ECMO (ECPELLA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive adult patients who received VA\u2010ECMO and underwent additional left ventricle unloading between January 2014 and March 2023 were studied. The primary endpoint was the number of ventilation\u2010free days. The secondary endpoints were serious bleeding, blood product consumption, thrombotic complications, and 28\u2010day mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 57 patients, 27 of whom received SBA\u2010ECMO and 30 of whom received ECPELLA. The median number of ventilation\u2010free days was 10 days (0\u201323) with SBA\u2010ECMO and 5 days (0\u201323) with the ECPELLA (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.61). According to the multivariable analyses, SBA\u2010ECMO was associated with a lower risk of serious bleeding (HR 0.31 [95% CI 0.12\u20130.80]) and less blood product consumption (RR 0.57 [95% CI 0.36\u20130.90]) than ECPELLA. Thrombotic complications and 28\u2010day mortality were similar between the groups before and after multivariable analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with left ventricle congestion during VA\u2010ECMO support, left ventricle unloading with SBA\u2010ECMO was associated with reduced serious bleeding and transfusions compared with ECPELLA, despite a similar number of ventilation\u2010free days, thrombotic complications, and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov identifiers: NCT03431467 and NCT05577195<\/jats:p>\n                  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