Microaxial Flow Pump for Left Ventricular Unloading After Aortic Valve Surgery

In hemodynamically unstable patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO), left ventricular unloading may be essential but technically challenging, especially after aortic valve replacement. We report a case of a 64-year-old male patient with postcardiotomy cardiogenic shock after combined coronary and aortic valve surgery. VA-ECMO alone was insufficient, prompting the use of a microaxial flow pump via axillary access. Challenges included left ventricle wiring through the closed bioprosthetic aortic valve and navigating a severely stenotic subclavian artery. A combination of advanced imaging and vascular techniques enabled successful device placement. A transesophageal ultrasound-guided mother-and-child technique with steerable catheter allows precise control for atraumatic valve crossing in case of functionally closed aortic leaflets. Intravascular lithotripsy is a potent tool to facilitate large-bore access for mechanical circulatory support in patients with calcified peripheral artery disease.