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Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation Case Series: A Single-Center Experience

Published:October 06, 2022DOI:https://doi.org/10.1016/j.jss.2022.08.020

      Highlights

      • Our series reviewed 33 patients who required VA ECMO support due to cardiogenic shock and had transseptal cannulation for left atrial drainage.
      • LAVA ECMO is an effective modality to treat left ventricular distention.
      • The timing of LAVA ECMO implementation is versatile.
      • It is, however, reasonable to consider that early initiation of LAVA to prevent LV distention and its complications would be advantageous.
      • There is a need for further evaluation of LAVA ECMO as a treatment modality for left heart decompression and direct comparisons of this technique against other methods used for left ventricular decompression.

      Abstract

      Introduction

      We aimed to review the characteristics and outcomes of left atrial veno-arterial extra corporeal membrane oxygenation (LAVA ECMO) at our institution over a 4-y period from 2017 to 2020.

      Methods

      Among 227 adult patients who received VA ECMO support from January 2017 to December 2020, we reviewed 33 of these who underwent transseptal cannulation and were converted to LAVA ECMO. The timing of transseptal cannulation, either at initiation of VA ECMO (n = 25) or with a later transseptal cannulation to treat complications of left ventricular (LV) distention while on VA ECMO (n = 8), was reviewed. The clinical characteristics, indications, echocardiography data, and outcomes were assessed.

      Results

      Duration of LAVA ECMO support ranged from 1 to 13 d, with a median of 5 d. Successful weaning from the LAVA ECMO circuit was achieved for 15 patients (45%). The in-hospital mortality rate was 66%. There were 11 patients (33%) who survived to be discharged from the hospital.

      Conclusions

      LV distention is a known complication of VA ECMO and impedes the recovery of the heart. LAVA ECMO provides a novel approach to treating LV distention. Additionally, our review shows that this modality may be used as a bridge to durable mechanical circulatory support, cardiac transplantation, or recovery.

      Keywords

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