Key result
LAVA-ECMO enables safe left atrial venting, successfully bridging extensive LV thrombus to durable LVAD.
Why the study?
Left ventricular thrombus complicating advanced cardiomyopathy poses challenges for mechanical circulatory support, especially when venting is required.
Case Report (n=1)
LAVA-ECMO provides a viable alternative for left atrial venting and hemodynamic stabilization in patients with cardiogenic shock when extensive LV thrombus contraindicates standard microaxial LVADs.
Answers are grounded in this paper and cite their sources.
May offer left atrial venting during ECMO when microaxial devices are contraindicated by thrombus; leaves open need for prospective validation.
BACKGROUND: Left ventricular thrombus complicating advanced cardiomyopathy poses challenges for mechanical circulatory support, especially when venting is required. CASE SUMMARY: The patient presented with anterolateral ST-segment elevation myocardial infarction from left ventricular thrombus embolization and underwent revascularization. He experienced arrest and was placed on venoarterial extracorporeal membrane oxygenation (ECMO). Extensive intracardiac thrombus contraindicated venting with a microaxial temporary left ventricular assist device (LVAD). Venoarterial ECMO was reconfigured to left atrial venoarterial ECMO (LAVA-ECMO), providing effective venting and hemodynamic support. Heart transplantation was deferred because of comorbidities. He was successfully bridged to high-risk durable LVAD implantation using meticulous surgical techniques. DISCUSSION: LAVA-ECMO enabled safe and effective venting when other typical strategies were contraindicated. This facilitated hemodynamic stabilization and successful bridging to definitive therapy. TAKE-HOME MESSAGES: LAVA-ECMO offers an alternative for left atrial venting when other methods are contraindicated. Durable LVADs can be safe in patients with extensive intracardiac thrombus using careful surgical techniques.
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Maigrot et al. (2025) conducted a case report in Cardiogenic shock with extensive left ventricular thrombus (n=1). Left atrial venoarterial extracorporeal membrane oxygenation (LAVA-ECMO) and durable LVAD was evaluated. LAVA-ECMO provided safe and effective left atrial venting in a patient with extensive left ventricular thrombus, facilitating hemodynamic stabilization and successful bridging to durable LVAD therapy.
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