LEFT ATRIAL VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION (LAVA-ECMO) AS A BRIDGE TO SURGICAL OR PERCUTANEOUS CLOSURE OF POST-MYOCARDIAL INFARCTION VENTRICULOSEPTAL DEFECTS (MI-VSD): A CASE SERIES
Recommended Citation
Fadel R, Alrayes H, Jabri A, Giustino G, Engel Gonzalez P, O’Neill BP, Lee JC, Nemeh H, Frisoli TM, Basir MB, O’Neill WW, Villablanca PA. LEFT ATRIAL VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION (LAVA-ECMO) AS A BRIDGE TO SURGICAL OR PERCUTANEOUS CLOSURE OF POST-MYOCARDIAL INFARCTION VENTRICULOSEPTAL DEFECTS (MI-VSD): A CASE SERIES. J Am Coll Cardiol 2025; 85(12):1377.
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
J Am Coll Cardiol
Keywords
adult, cannulation, cardiogenic shock, case report, case study, clinical article, complication, conference abstract, extracorporeal oxygenation, female, heart afterload, heart infarction, heart left atrium, heart left ventricle ejection fraction, heart right atrium, heart ventricle septum defect, hemodynamic monitoring, human, left ventricular pressure, male, middle aged, mortality rate, special situation for pharmacovigilance, surgery, therapy, veno-arterial ECMO
Abstract
Background: Post-myocardial infarct (MI) ventricular septal defect (VSD) is a rare complication with a high mortality rate. The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to surgical or percutaneous repair has been published, but is limited to small case series primarily utilizing surgical ECMO, with the main drawback of potentially increasing afterload and left ventricle pressure, further worsening VSD shunting. Left-atrial VA-ECMO (LAVA-ECMO) can potentially absolve this concern, utilizing bi-atrial drainage through a trans-septal fenestrated cannula. Methods Consecutive cases were reviewed from 2018-2023 at a quaternary care center in Metropolitan Detroit. Results 5 patients were included, all with VSD secondary to MI, and managed with LAVA-ECMO as a bridge to repair. Average age was 62 ± 4.2 years, and left ventricular ejection fraction of 46.6 ± 13.8%. Hemodynamic monitoring demonstrated improvement in right atrial, right ventricular, pulmonary, left atrial, and left ventricular pressures post cannulation. Average time to repair was 7.4 ± 3.9 days. All 5 patients survived to repair, with 4 undergoing surgical and 1 undergoing percutaneous closure. Conclusion This case series highlights LAVA-ECMO as a bridge to MI-VSD repair in patients with cardiogenic shock. Bi-atrial drainage with LV unloading makes LAVA-ECMO a desirable cannulation strategy in patients with large VSD, and provides cardiopulmonary support pending definitive treatment. [Formula presented]
Volume
85
Issue
12
First Page
1377
