Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation In Valvular Cardiogenic Shock
Recommended Citation
Giustino G, Fadel RA, Jabri A, Cowger J, O'Neill B, Basir MB, Engel Gonzalez P, Frisoli T, Lee J, Généreux P, O'Neill WW, and Villablanca PA. Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation In Valvular Cardiogenic Shock. J Soc Cardiovasc Angiogr Interv 2025; 4(5):102615.
Document Type
Article
Publication Date
5-1-2025
Publication Title
J Soc Cardiovasc Angiogr Interv
Abstract
BACKGROUND: Treatment of valvular cardiogenic shock (VCS) is challenging as the options for mechanical cardiocirculatory support are limited. Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) is a mechanical cardiocirculatory support strategy that provides cardiocirculatory support and simultaneous left ventricular unloading, compared to traditional VA-ECMO.
METHODS: This is a single-center retrospective analysis of patients with VCS who underwent LAVA-ECMO between 2018 and 2023. During LAVA-ECMO, the ECMO venous cannula is placed transeptally in the LA, therefore providing active biventricular unloading.
RESULTS: A total of 18 patients who had VCS and underwent LAVA-ECMO cannulation were included. Among patients with VCS, 10 were related to the aortic valve (55.6%), 7 to the mitral valve (38.9%), and 1 to the tricuspid valve (5.6%). Four patients (22.2%) had multivalvular disease. The median age was 65 years, most were men (66.7%) and most were in Society for Cardiovascular Angiography & Interventions cardiogenic shock stage D or E (89%). LAVA-ECMO was associated with substantial improvement in hemodynamics, including lower right atrial pressure (-8 mm Hg; 95% CI, 7.0-9.5; P = .004), mean pulmonary artery systolic pressure (-18.5 mm Hg; 95% CI, 14.3-21.7; P = .026), pulmonary capillary wedge pressure (-14.5 mm Hg; 95% CI, 12.8-12.3; P = .003), and left ventricular end-diastolic pressure (-20.0 mm Hg; 95% CI, 16.5-21.0; P < .001). These effects were consistent across VCS types. There were no complications from transeptal cannulation. Survival to a transcatheter or surgical procedure was 69.1%, and survival to hospital discharge was 44.4%.
CONCLUSIONS: LAVA-ECMO appears to be feasible, safe, and associated with improved hemodynamics in patients with VCS. Further research is needed to evaluate whether LAVA-ECMO as a bridge treatment strategy to intervention is beneficial in VCS.
PubMed ID
40454278
Volume
4
Issue
5
First Page
102615
Last Page
102615
