Left atrial veno-arterial extracorporeal membrane oxygenation as a bridge to surgical or percutaneous closure of post-myocardial infarction ventriculoseptal defects: a case series
Abstract
Abstract Background Post-myocardial infarct (MI) ventricular septal defect (VSD) is a rare and severe complication of an acute MI with high mortality rate. The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to surgical or percutaneous repair in cardiogenic shock secondary to post-MI-VSD has been published, but is limited to small case series primarily utilizing surgical ECMO, with the main drawback of potentially increasing afterload and left ventricle pressure, further worsening VSD shunting. Left-atrial VA-ECMO (LAVA-ECMO) can potentially absolve this concern given that it utilizes bi-atrial drainage through a trans-septal fenestrated cannula. Case summary Five patients were included in this series, all with VSD secondary to MI, and all managed with LAVA-ECMO as a bridge to repair. Average age was 62 ± 4.2 years, body mass index of 29.4 ± 4.5 kg/m2, and left ventricular ejection fraction of 46.6 ± 13.8%. Haemodynamics monitoring pre- and post-LAVA-ECMO demonstrated improvement in right atrial, right ventricular, pulmonary, left atrial, and left ventricular pressures (Figure 1). Average time to repair was 7.4 ± 3.9 days. All five patients survived to repair, with four undergoing surgical and one undergoing percutaneous closure. Four out of five patients were decannulated successfully. Discussion This case series reports the successful use of LAVA-ECMO as a bridge to MI-VSD repair in patients with cardiogenic shock. Left-atrial VA-ECMO serves…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials
- Tocilizumab in patients with severe COVID-19: a retrospective cohort study
- A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: A cohort study
- Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study
- Are noise and air pollution related to the incidence of dementia? A cohort study in London, England
- Long COVID symptoms and duration in SARS-CoV-2 positive children — a nationwide cohort study
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.