Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation: Percutaneous Bi-Atrial Drainage to Avoid Pulmonary Edema in Patients With Left Ventricular Systolic Dysfunction

Dulnuan, Kenneth; Guglin, Maya; Zwischenberger, Joseph B.; Gurley, John C.

doi:10.1016/s0735-1097(18)31899-0

Cited by 14 publications

(15 citation statements)

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“…63 Left atrial VA ECMO involves the trans-septal placement of a venous femoral cannula to simultaneously drain both atria in patients with severe left ventricular systolic dysfunction. 64 Left atrial VA ECMO allows the drainage of both atria and decreases pulmonary oedema in patients with severe heart failure. 64 In recent years, VA ECMO has become the firstline therapy in the setting of CS unresponsive to standard therapy, since it provides both respiratory and cardiac support, is easy to insert and can stay in place for several days as a bridge to making a decision, which could be for recovery, transplantation or long-term mechanical support.…”

Section: Protekduomentioning

confidence: 99%

“…64 Left atrial VA ECMO allows the drainage of both atria and decreases pulmonary oedema in patients with severe heart failure. 64 In recent years, VA ECMO has become the firstline therapy in the setting of CS unresponsive to standard therapy, since it provides both respiratory and cardiac support, is easy to insert and can stay in place for several days as a bridge to making a decision, which could be for recovery, transplantation or long-term mechanical support. [65][66][67][68] However, despite advances in technology and cannulation strategies over time, the prognosis of patients in refractory CS supported with ECMO remains poor.…”

Section: Protekduomentioning

confidence: 99%

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Temporary Mechanical Circulatory Support in Acute Heart Failure

et al. 2020

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Cardiogenic shock (CS) is a challenging syndrome, associated with significant morbidity and mortality. Although pharmacological therapies are successful and can successfully control this acute cardiac illness, some patients remain refractory to drugs. Therefore, a more aggressive treatment strategy is needed. Temporary mechanical circulatory support (TCS) can be used to stabilise patients with decompensated heart failure. In the last two decades, the increased use of TCS has led to several kinds of devices becoming available. However, indications for TCS and device selection are part of a complex process. It is necessary to evaluate the severity of CS, any early and prompt haemodynamic resuscitation, prior TCS, specific patient risk factors, technical limitations and adequacy of resources and training, as well as an assessment of whether care would be futile. This article examines options for commonly used TCS devices, including intra-aortic balloon pumps, a pulsatile percutaneous ventricular assist device (the iVAC), veno-arterial extra-corporeal membrane oxygenation and Impella (Abiomed) and TandemHeart (LivaNova) percutaneous ventricular assist device.

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Section: Protekduomentioning

confidence: 99%

Section: Protekduomentioning

confidence: 99%

Temporary Mechanical Circulatory Support in Acute Heart Failure

et al. 2020

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“…24)42) This approach is referred to as LV-VA ECMO. 43) B. Harlequin syndrome: During ECMO, perfusate blood from ECMO mixes in the aorta with LV blood that has traversed the lungs. Therefore, the content of oxygen and carbon dioxide in the patient's arterial blood represents a combination of blood from these 2 sources.…”

Section: Components and Cannulationmentioning

confidence: 99%

Mechanical Circulatory Support for Acute Heart Failure Complicated by Cardiogenic Shock

2020

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Acute heart failure is a potentially life-threatening condition that can lead to cardiogenic shock, which is associated with hypotension and organ failure. Although there have been many studies on the treatment for cardiogenic shock, early mortality remains high at 40-50%. No new medicines for cardiogenic shock have been developed. Recently, there has been a gradual decline in the use of the intra-aortic balloon pump mainly due to a lack of adequate hemodynamic support. Extracorporeal membrane oxygenation and the percutaneous ventricular assist device have become more widely used in recent years. A thorough understanding of the mechanisms of such mechanical support devices and their hemodynamic effects, components of the devices, implantation technique, management, criteria for indications or contraindications of use, and clinical outcomes as well as multidisciplinary decision making may improve the outcomes in patients experiencing cardiogenic shock.

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“…A 53‐year‐old male patient with chronic combined heart failure (HF) due to dilated ischemic cardiomyopathy presented in cardiogenic shock to the hybrid catheterization lab for institution of veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) as a bridge to cardiac transplantation. To provide adequate drainage and decompression of both right and left atria, the decision was made to place a single venous cannula across the interatrial septum (IAS) with the goal of positioning the distal orifice and side ports within the left atrium (LA) and the proximal set of side ports within the right atrium (RA) or inferior vena cava (IVC) for left atrial veno‐arterial (LAVA)‐ECMO 1,2 . Three‐dimensional (3D) transesophageal echocardiography (TEE) was employed to guide cannula placement and positioning.…”

Section: Introductionmentioning

confidence: 99%

Utility of three‐dimensional transesophageal echocardiography to guide transseptal positioning of a single multistage venous cannula to provide both venous drainage and indirect left ventricular venting in veno‐arterial extracorporeal membrane oxygenation

et al. 2020

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A patient with heart failure due to dilated ischemic cardiomyopathy presented in cardiogenic shock for institution of veno‐arterial extracorporeal membrane oxygenation as a bridge to cardiac transplantation. To provide adequate venous drainage and simultaneous decompression of the left atrium (indirect left ventricular venting), a single venous cannula was placed across the interatrial septum so that the distal orifice and side ports were located within the left atrium and the proximal set of side ports were positioned at the cavoatrial junction. Three‐dimensional transesophageal echocardiography demonstrated utility in guiding cannula placement and appropriate positioning within the left atrium.

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Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation: Percutaneous Bi-Atrial Drainage to Avoid Pulmonary Edema in Patients With Left Ventricular Systolic Dysfunction

Cited by 14 publications

References 0 publications

Temporary Mechanical Circulatory Support in Acute Heart Failure

Temporary Mechanical Circulatory Support in Acute Heart Failure

Mechanical Circulatory Support for Acute Heart Failure Complicated by Cardiogenic Shock

Utility of three‐dimensional transesophageal echocardiography to guide transseptal positioning of a single multistage venous cannula to provide both venous drainage and indirect left ventricular venting in veno‐arterial extracorporeal membrane oxygenation

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