UTILIZING TRANSCAVAL LEFT ATRIAL VENOUS ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION AS A BRIDGE TO MITRACLIP IN ACUTE MITRAL REGURGITATION

Document Type

Conference Proceeding

Publication Date

3-7-2023

Publication Title

J Am Coll Cardiol

Abstract

Background: Transcaval Left-atrial venous arterial ECMO (TC-LAVA-ECMO), mechanical circulatory support (MSC) device, can be utilized as a bridge to provide biventricular cardiac support and improve oxygenation in cardiogenic shock. A single cannula is inserted using the inferior vena cava (IVC) access which necessitates transeptal puncture to decompress the right and left atria.

Case: 49-year-old renal transplant patient on tacrolimus and prednisone with a history of hypertension, type 2 DM, adrenal insufficiency, and significant recurrent infections presented with cardiogenic shock complicated by sepsis and hypoxic respiratory failure. The patient was admitted to the MICU, intubated, and placed on vasopressors, inotropes, wide-spectrum antibiotics, and antifungals. Radiographic imaging was consistent with edema and multifocal pneumonia. Echocardiography revealed new flail P2 characteristic of chordal apparatus rupture causing acute mitral regurgitation. Infectious endocarditis secondary to methicillin-susceptible staphylococcus epidermidis bacteremia was suspected to cause the chordal apparatus rupture. The patient's hospital course was complicated by renal failure, persistent ventricular tachycardia, escalating vasopressors and inotropes, and worsening hemodynamics.

Decision-making: The patient was evaluated for surgical mitral valve repair or replacement but deemed high risk for surgical intervention. A decision was made to utilize LAVA-ECMO as a bridge to MitraClip procedure to improve the patient's condition.

Conclusion: We report the utilization of TC-LAVA-ECMO as a bridge providing biventricular cardiac support and hemodynamic improvement. Unlike veno-arterial-ECMO, which increases the left ventricle (LV) afterload and myocardial oxygen demand without an additional left atrial cannula to unload the LV. TC-LAVA-ECMO eliminates the need for additional MCS devices with single arterial access with a significantly lower risk for bleeding and access site-related ischemia. This approach should be considered for complicated cases in centers with experienced ECMO programs.

Volume

81

Issue

8

First Page

3701

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