AORTIC VALVE THROMBUS ASSOCIATED WITH LEFT ATRIAL VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION (LAVA-ECMO) WHILE ON BIVALIRUDIN
Recommended Citation
Nguyen F, Fadel R, Cowger JA, Nemeh H, Basir MB. AORTIC VALVE THROMBUS ASSOCIATED WITH LEFT ATRIAL VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION (LAVA-ECMO) WHILE ON BIVALIRUDIN. J Am Coll Cardiol 2025; 85(12):3322.
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
J Am Coll Cardiol
Keywords
bivalirudin, diuretic agent, heparin, acute hypoxemic respiratory failure, adult, anticoagulation, aortic valve, cannula, cannulation, cardiogenic shock, case report, clinical article, complication, conference abstract, diagnosis, drug therapy, echocardiograph, echocardiography, extracorporeal oxygenation, frontal lobe, heart afterload, heart catheterization, heart failure, heart left atrium, heart output, human, intubation, lactic acidosis, left ventricular assist device, male, middle aged, nonischemic cardiomyopathy, outpatient department, respiratory failure, surgery, thromboembolism, thrombus, vein thrombosis, veno-arterial ECMO
Abstract
Background: LAVA-ECMO is an ECMO configuration that uses a single trans-septal cannula to provide biventricular unloading. Despite its advantages, the risk of thrombosis remains. Case A 32-year-old male with a history of nonischemic cardiomyopathy and recurrent venous thromboses on apixiban was admitted with decompensated heart failure. Right heart catheterization showed elevated filling pressures and very reduced cardiac output. He is started on diuretics and afterload reducing agents. On hospital day #4, he develops worsening cardiogenic shock with severe lactic acidosis and acute hypoxic respiratory failure requiring intubation. He is taken urgently for LAVA-ECMO. Decision-making Given the patientʼs thrombosis history, body habitus, and difficulties maintaining heparin at therapeutic range, heparin was switched to bivalirudin after cannulation. After 3 days, his mental status declines. A transesophageal echocardiogram was performed revealing severe smoke around the aortic valve and root, suspicious for thrombus. A CT head was performed showing an acute infarct in the right frontal lobe. Bivalirudin is switched back to heparin. Discussions of durable support are expedited, and patient is taken for LVAD. He is subsequently extubated and demonstrated intact neurologic function. Conclusion In this patient with thromboembolic history, bivalirudin may not have provided adequate anticoagulation while on ECMO. Improving protocols for anticoagulation for ECMO may help reduce this risk. [Formula presented]
Volume
85
Issue
12
First Page
3322
