Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2023; 11(27): 6531-6536
Published online Sep 26, 2023. doi: 10.12998/wjcc.v11.i27.6531
Left atrium veno-arterial extra corporeal membrane oxygenation as temporary mechanical support for cardiogenic shock: A case report
Rossana Lamastra, David Michael Abbott, Antonella Degani, Carlo Pellegrini, Roberto Veronesi, Stefano Pelenghi, Chiara Dezza, Giulia Gazzaniga, Mirko Belliato
Rossana Lamastra, David Michael Abbott, Giulia Gazzaniga, Department of Surgical, Pediatric and Diagnostic Sciences, University of Pavia, Pavia 27100, PV, Italy
Antonella Degani, Department of Cardiothoracic Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, PV, Italy
Carlo Pellegrini, Clinical, Surgical, Diagnostic and Pediatric Sciences Department, University of Pavia, Italy - Department of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo Foundation, Pavia 27100, PV, Italy
Roberto Veronesi, Chiara Dezza, Mirko Belliato, SC-AR2 Anestesia e Terapia Intensiva Cardiotoracica Fondazione IRCCS Policlinico San Matteo, Pavia 27100, PV, Italy
Stefano Pelenghi, Department of Cardiac Surgery 1, IRCCS University Hospital Foundation "San Matteo", Pavia 27100, Italy
Author contributions: Abbott DM and Lamastra R contributed equally to this work through manuscript writing and editing: Degani A, Pellegrini C, Veronesi R, Pelenghi R, Dezza C, Gazzaniga G and Belliato M contributed to data collection, revision, conceptualization, and supervision.
Supported by EUROSETS srl Italy for the Open Access Fee.
Informed consent statement: The informed consent was waived due to the retrospective nature of the report and unfortunate death of the patient.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: David Michael Abbott, MD, Doctor, Department of Surgical, Pediatric and Diagnostic Sciences, University of Pavia, Viale Camillo Golgi, 19, Pavia 27100, PV, Italy. david.abbott01@universitadipavia.it
Received: June 1, 2023
Peer-review started: June 1, 2023
First decision: August 2, 2023
Revised: August 10, 2023
Accepted: August 23, 2023
Article in press: August 23, 2023
Published online: September 26, 2023
Processing time: 111 Days and 1.9 Hours
Abstract
BACKGROUND

Veno-arterial extra corporeal membrane oxygenation (VA-ECMO) support is commonly complicated with left ventricle (LV) distension in patients with cardiogenic shock. We resolved this problem by transeptally converting VA-ECMO to left atrium veno-arterial (LAVA)-ECMO that functioned as a temporary paracorporeal left ventricular assist device to resolve LV distension. In our case LAVA-ECMO was also functioning as a bridge-to-transplant device, a technique that has been scarcely reported in the literature.

CASE SUMMARY

A 65 year-old man suffered from acute myocardial injury that required percutaneous stents. Less than two weeks later, noncompliance to antiplatelet therapy led to stent thrombosis, cardiogenic shock, and cardiac arrest. Femoro-femoral VA-ECMO support was started, and the patient underwent a second coronary angiography with re-stenting and intra-aortic balloon pump placement. The VA-ECMO support was complicated by left ventricular distension which we resolved via LAVA-ECMO. Unfortunately, episodes of bleeding and sepsis complicated the clinical picture and the patient passed away 27 d after initiating VA-ECMO.

CONCLUSION

This clinical case demonstrates that LAVA-ECMO is a viable strategy to unload the LV without another invasive percutaneous or surgical procedure. We also demonstrate that LAVA-ECMO can also be weaned to a left ventricular assist device system. A benefit of this technique is that the procedure is potentially reversible, should the patient require VA-ECMO support again. A transeptal LV venting approach like LAVA-ECMO may be indicated over ImpellaTM in cases where less LV unloading is required and where a restrictive myocardium could cause LV suctioning. Left ventricular over-distention is a well-known complication of peripheral VA-ECMO in cardiogenic shock and LAVA ECMO through transeptal cannulation offers a novel and safe approach for treating LV overloading, without the need of an additional percutaneous access.

Keywords: Left atrium venoarterial extra corporeal membrane oxygenation; Shock; Case report

Core Tip: We report a clinical case of a 65-year-old man with cardiogenic shock after a myocardial infarction that required veno-arterial extra corporeal membrane oxygenation (VA-ECMO) support which was transeptally converted to left atrium veno-arterial (LAVA)-ECMO that then functioned as a temporary paracorporeal LVAD. This solution resolved left ventricular distension and served as a bridge-to-transplant.