Hemodynamic Effects and Clinical Outcomes of Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO) in Cardiogenic Shock

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Pedro Arturo Villablanca MD , Raef Ali Fadel DO , Gennaro Giustino MD , Ahmad Jabri MD , Mir Babar Basir Do , Jennifer Cowger MD , Khaldoon Alaswad MD , Brian O'Neill MD , Pedro Engel Gonzalez MD , Gillian Grafton Gyzm Do , Tiberio Frisoli MD , James Lee MD , Lindsey Aurora MD , Sarah Gorgis MD , Hassan Nemeh MD , Dimitrios Apostolou MD , Mohammad Alqarqaz MD , Gerald C. Koenig MD, PhD , Herbert D. Aronow MD , Brittany Fuller MD , William O'Neill MD
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Abstract

Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) in cardiogenic shock (CS) is a novel mechanical cardiocirculatory support strategy that provides robust cardiocirculatory support and simultaneous left and right atrial venting by way of a multifenestrated transeptal catheter. We performed a single-center retrospective analysis of all patients aged ≥18 years with CS who underwent LAVA-ECMO at a quaternary care institution from 2018 to 2023. Clinical outcomes and prehemodynamics and posthemodynamics were evaluated. A total of 68 patients were analyzed (75% were men, 72% were white, median age of 63 years). The indications for LAVA-ECMO were CS because of myocardial infarction (29.4%), biventricular failure (26.5%), and/or valvular heart disease (26.5%). Trans-septal puncture was guided by intracardiac echocardiography (86.8%) or transesophageal echocardiography (13.2%). Arterial cannulation was performed by way of transcaval access in 25% of the cases. Post-LAVA-ECMO cannulation was associated with substantial improvement in the hemodynamics within 24 hours after cannulation, including reduction in right atrial pressure (absolute mean difference: −5.0 mm Hg, p <0.001), mean pulmonary artery pressure (−9.0 mm Hg, p <0.001), pulmonary capillary wedge pressure (−10.0 mm Hg, p <0.001), and left ventricular end-diastolic pressure (−14.0 mm Hg, p <0.001). Survival to decannulation occurred in 69.1%, whereas the 30-day survival from cannulation was 51.5%. The in-hospital all-cause mortality was 51.5%. Only 5 patients (7.4%) required additional mechanical circulatory support (MCS) (4 Impella, 1 veno-arterio-venous extracorporeal membrane oxygenation). There were no complications related to transeptal placement of the venous ECMO cannula. In conclusion, LAVA-ECMO, an MCS strategy providing biatrial drainage, appears to also provide simultaneous left ventricular venting, as demonstrated by improved invasive hemodynamics. Although the procedure appears safe, with no direct complications to interatrial septal cannulation, postcannulation complications remain high, and further studies are needed to evaluate the full safety profile of LAVA-ECMO compared with alternative MCS strategies.
左心房静脉-动脉体外膜氧合(LAVA-ECMO)对心源性休克的血流动力学效应和临床疗效。
CS 中的左心房静脉-动脉体外膜氧合(LAVA-ECMO)是一种新型的机械性心循环支持策略,它通过多瘘管经皮导管提供强有力的心循环支持并同时进行左心房和右心房通气。我们对2018-2023年期间在一家四级医疗机构接受LAVA-ECMO治疗的所有年龄≥18岁的CS患者进行了单中心回顾性分析。对临床结果以及前后血流动力学进行了评估。共分析了 68 名患者(75% 为男性,72% 为白人,中位年龄为 63 岁)。LAVA-ECMO的适应症为心肌梗死导致的CS(29.4%)、双心室衰竭(26.5%)和/或瓣膜性心脏病(26.5%)。经静脉穿刺由心内超声心动图(86.8%)或经食道超声心动图(13.2%)引导。25%的病例通过经腔入路进行动脉插管。LAVA-ECMO 插管后 24 小时内,血液动力学状况得到了显著改善,包括右心房压力降低(绝对平均差:-5.0 mmHg,P<0.05):-5.0毫米汞柱,p
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来源期刊
American Journal of Cardiology
American Journal of Cardiology 医学-心血管系统
CiteScore
4.00
自引率
3.60%
发文量
698
审稿时长
33 days
期刊介绍: Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.
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