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Case Reports
. 2022 Mar 2;4(5):276-279.
doi: 10.1016/j.jaccas.2021.12.030.

Left Atrial Venoarterial Extracorporeal Membrane Oxygenation for Acute Aortic Regurgitation and Cardiogenic Shock

Michael Chiang  1 , Pedro E Gonzalez  1 , Brian P O'Neill  1 , James Lee  1 , Tiberio Frisoli  1 , Dee Dee Wang  1 , William W O'Neill  1 , Pedro A Villablanca  1
Affiliations
Case Reports

Left Atrial Venoarterial Extracorporeal Membrane Oxygenation for Acute Aortic Regurgitation and Cardiogenic Shock

Michael Chiang et al. JACC Case Rep. .

Abstract

A 51-year-old man with past medical history of bioprosthetic aortic valve replacement presented in cardiogenic shock secondary to acute bioprosthesis degeneration with severe aortic regurgitation. Venoarterial extracorporeal membrane oxygenation is contraindicated in patients with severe AI. Use of left atrial venoarterial extracorporeal membrane oxygenation resulted in hemodynamic improvement, allowing patient stabilization for emergency valve-in-valve transcatheter aortic valve replacement. (Level of Difficulty: Advanced.).

Keywords: AI, aortic insufficiency; LA, left atrial; LAVA-ECMO; LAVA-ECMO, left atrial venoarterial extracorporeal membrane oxygenation; LV, left ventricle; MCS, mechanical circulatory support; RA, right atrial; TAVR, transcatheter aortic valve replacement; VA-ECMO; VA-ECMO, venoarterial extracorporeal membrane oxygenation; aortic regurgitation; cardiogenic shock.

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Conflict of interest statement

Dr B.P. O’Neill is a consultant to and receives research support from Edwards Lifesciences. Dr Frisoli is a proctor for Edwards Lifesciences, Abbott, Boston Scientific, and Medtronic. Dr Wang is a consultant for Edwards Lifesciences, Abbott, Neochord, and Boston Scientific and receives research grant support from Boston Scientific assigned to employer Henry Ford Health System. Dr W.W. O’Neill has served as a consultant for Abiomed, Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Vascular, and St. Jude Medical and serves on the Board of Directors of Neovasc Inc. Dr Villablanca is a consultant for Edwards Lifesciences and Teleflex. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Left Coronary Artery Angiogram
Figure 2
Figure 2
Hemodynamics Before and After LAVA-ECMO CI = cardiac index; CO = cardiac output; CPO = cardiac power output; IABP = intra-aortic balloon pump; LAVA-ECMO = left atrial venoarterial extracorporeal membrane oxygenation; PAPi = pulmonary artery pulsatility index.
Figure 3
Figure 3
Septostomy With Peripheral Balloon Before Left Atrial Venoarterial Extracorporeal Membrane Oxygenation Venous Cannula Insertion
See this image and copyright information in PMC

References

    1. Sidebotham D., Allen S., McGreorge A., et al. Catastrophic left heart distension following initiation of venoarterial extracorporeal membrane oxygenation in a patient with mild aortic regurgitation. Anaesth Intensive Care. 2012;40(3):568–569. - PubMed
    1. Dulnuan K., Guglin M., Zwischenberger J., et al. Left atrial veno-arterial extracorporeal membrane oxygenation: percutaneous bi-atrial drainage to avoid pulmonary edema in patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 2018;71(11 suppl):A1358.

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