Hemodynamic Effects and Clinical Outcomes of Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO) in Cardiogenic Shock
Recommended Citation
Fadel R, Villablanca P, Giustino G, Jabri A, Basir MB, Cowger JA, Alaswad K, O’Neill B, Engel Gonzalez P, Grafton G, Frisoli T, Lee J, Aurora L, Gorgis S, Nemeh H, Apostolou D, Alqarqaz M, Koenig G, Aronow H, Fuller B, Aggarwal V, O’Neill W. Hemodynamic Effects and Clinical Outcomes of Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO) in Cardiogenic Shock. ASAIO J 2024; 70:7.
Document Type
Conference Proceeding
Publication Date
9-1-2024
Publication Title
ASAIO J
Keywords
adult, aged, all cause mortality, cannulation, cardiogenic shock, Caucasian, clinical outcome, cohort analysis, complication, conference abstract, decannulation, extracorporeal membrane oxygenation cannula, extracorporeal oxygenation, female, heart atrium, heart infarction, heart left atrium, heart right atrium, heart right atrium pressure, hemodynamics, human, intracardiac echocardiography, left ventricular end-diastolic pressure, lung artery pressure, lung wedge pressure, major clinical study, male, pulmonary artery occlusion pressure, retrospective study, surgery, transesophageal echocardiography, valvular heart disease, veno-arterial ECMO, ventricular assist device
Abstract
Background: Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) 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. Methods: This is a single-center retrospective analysis of all patients who underwent LAVA-ECMO at a quaternary care institution from 2018-2023. Clinical outcomes including pre- and post-hemodynamics were evaluated. Results: A total of 68 patients were included (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. Conclusion: LAVA-ECMO, a MCS strategy providing bi-atrial drainage and thus simultaneous LV venting, appears to be a feasible and efficacious treatment modality in select patients. Further studies are needed to evaluate the safety profile of LAVA-ECMO compared to alternative MCS strategies.
Volume
70
First Page
7
