Left Atrial Venoarterial Extracorporeal Membrane Oxygenation Strategy in Postcardiotomy Cardiogenic Shock: A Case Series

Postcardiotomy cardiogenic shock is a rare complication with high mortality. When patients do not respond to the placement of an intra-aortic balloon pump or pharmacological treatment, therapy with peripheral venoarterial extracorporeal membrane is a viable option that allows active resuscitation. The adjunct use of Impella® (Abiomed, Danvers, MA, USA) allows active unloading of the dysfunctional left ventricle. However, left atrial venoarterial extracorporeal membrane oxygenation (LAVA-ECMO) is an appealing and effective strategy in cases of aortic dissection, aortic valve replacement, or bioprosthesis of the aorta. Insertion of an extraction cannula that can discharge both atria or only the left atrium allows biventricular discharge or discharge of only the left ventricle, respectively. We present a case series of patients who underwent Bentall–De Bono surgery with severe aortic regurgitation secondary to aortic dissection and/or aneurysm. In one case, the aortic dissection extended before the bifurcation of the iliac arteries, and LAVA-ECMO was a safe treatment option. To our knowledge, this is the first published experience of LAVA-ECMO after cardiac surgery in this population.