Hemodynamic Effects and Clinical Outcomes of Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO) in Cardiogenic Shock

Authors

Pedro Villablanca, Henry Ford HealthFollow
Raef Fadel, Henry Ford HealthFollow
Gennaro Giustino, Henry Ford HealthFollow
Ahmad Jabri, Henry Ford HealthFollow
Mir B. Basir, Henry Ford HealthFollow
Jennifer A. Cowger, Henry Ford HealthFollow
Khaldoon Alaswad, Henry Ford HealthFollow
Brian P. O'Neill, Henry Ford HealthFollow
Pedro Engel Gonzalez, Henry Ford HealthFollow
Gillian Grafton, Henry Ford HealthFollow
Tiberio Frisoli, Henry Ford HealthFollow
James Lee, Henry Ford HealthFollow
Lindsey Aurora, Henry Ford HealthFollow
Sarah Gorgis, Henry Ford HealthFollow
Hassan Nemeh, Henry Ford HealthFollow
Dimitrios Apostolou, Henry Ford HealthFollow
Mohammad Alqarqaz, Henry Ford HealthFollow
Gerald C. Koenig, Henry Ford HealthFollow
Herbert D. Aronow, Henry Ford HealthFollow
Brittany S. Fuller, Henry Ford HealthFollow
Vikas Aggarwal, Henry Ford HealthFollow
William O'Neill, Henry Ford HealthFollow

Recommended Citation

Villablanca PA, Fadel RA, Giustino G, Jabri A, Basir MB, Cowger J, Alaswad K, O'Neill B, Gonzalez PE, Gyzm GG, Frisoli T, Lee J, Aurora L, Gorgis S, Nemeh H, Apostolou D, Alqarqaz M, Koenig GC, Aronow HD, Fuller B, Aggarwal V, and O'Neill W. Hemodynamic Effects and Clinical Outcomes of Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO) in Cardiogenic Shock. Am J Cardiol 2024.

Document Type

Article

Publication Date

2-1-2025

Publication Title

The American journal of cardiology

Abstract

Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) in CS is a novel mechanical cardiocirculatory support strategy that provides robust cardiocirculatory support and simultaneous left and right atrial venting via a multi-fenestrated transeptal catheter. We performed a single-center retrospective analysis of all patients aged ≥ 18 years with CS who underwent LAVA-ECMO at a quaternary care institution from 2018-2023. Clinical outcomes as well as pre- and post-hemodynamics were evaluated. A total of 68 patients were analyzed (75% male, 72% white, median age 63). Indications for LAVA-ECMO were CS due to myocardial infarction (29.4%), biventricular failure (26.5%), and/or valvular heart disease (26.5%). Trans-septal puncture was guided by intracardiac echocardiography (86.8%) or transesophageal echocardiography (13.2%). Arterial cannulation was performed via transcaval access in 25% of the cases. Post-LAVA-ECMO cannulation was associated with substantial improvement in the hemodynamics within 24 hours post cannulation, including reduction in right atrial pressure (absolute mean difference: -5.0 mmHg, p<0.001), mean pulmonary artery pressure (-9.0 mmHg, p<0.001), pulmonary capillary wedge pressure (-10.0 mmHg, p<0.001), and LV end-diastolic pressure (-14.0 mmHg, p<0.001). Survival to decannulation occurred in 69.1%, while 30-day survival from cannulation was 51.5%. In-hospital all-cause mortality was 51.5%. Only 5 patients (7.4%) required additional MCS (4 Impella, 1 VAV-ECMO). There were no complications related to transeptal placement of the venous ECMO cannula. In conclusion, LAVA-ECMO, a MCS strategy providing bi-atrial drainage, appears to also provide simultaneous LV venting as demonstrated by improved invasive hemodynamics. Although the procedure itself appears safe, with no direct complications to interatrial septal cannulation, post-cannulation complications remain high, and further studies are needed to evaluate the full safety profile of LAVA-ECMO compared to alternative MCS strategies.

Medical Subject Headings

Humans; Extracorporeal Membrane Oxygenation; Male; Shock, Cardiogenic; Female; Middle Aged; Retrospective Studies; Hemodynamics; Aged; Heart Atria; Treatment Outcome

PubMed ID

39547341

ePublication

ePub ahead of print

Volume

236

First Page

79

Last Page

85