Department of Surgery, University of Kentucky, Lexington, Kentucky; Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky.
UK College of Medicine - 3(rd) Year, University of Kentucky, Lexington, Kentucky.
J Surg Res. 2023 Jan;281:238-244. doi: 10.1016/j.jss.2022.08.020. Epub 2022 Oct 6.
We aimed to review the characteristics and outcomes of left atrial veno-arterial extra corporeal membrane oxygenation (LAVA ECMO) at our institution over a 4-y period from 2017 to 2020.
Among 227 adult patients who received VA ECMO support from January 2017 to December 2020, we reviewed 33 of these who underwent transseptal cannulation and were converted to LAVA ECMO. The timing of transseptal cannulation, either at initiation of VA ECMO (n = 25) or with a later transseptal cannulation to treat complications of left ventricular (LV) distention while on VA ECMO (n = 8), was reviewed. The clinical characteristics, indications, echocardiography data, and outcomes were assessed.
Duration of LAVA ECMO support ranged from 1 to 13 d, with a median of 5 d. Successful weaning from the LAVA ECMO circuit was achieved for 15 patients (45%). The in-hospital mortality rate was 66%. There were 11 patients (33%) who survived to be discharged from the hospital.
LV distention is a known complication of VA ECMO and impedes the recovery of the heart. LAVA ECMO provides a novel approach to treating LV distention. Additionally, our review shows that this modality may be used as a bridge to durable mechanical circulatory support, cardiac transplantation, or recovery.
我们旨在回顾 2017 年至 2020 年期间，我院 4 年内左心房动静脉体外膜肺氧合（LAVA ECMO）的特点和结果。
在 2017 年 1 月至 2020 年 12 月期间接受 VA ECMO 支持的 227 例成年患者中，我们回顾了其中 33 例接受经房间隔穿刺并转为 LAVA ECMO 的患者。回顾了经房间隔穿刺的时机，一种是在 VA ECMO 开始时（n=25），另一种是在 VA ECMO 期间因左心室（LV）扩张而出现并发症时进行（n=8）。评估了临床特征、适应证、超声心动图数据和结局。
LAVA ECMO 支持的时间从 1 天到 13 天不等，中位数为 5 天。15 例患者（45%）成功脱离 LAVA ECMO 回路。院内死亡率为 66%。有 11 例患者（33%）存活并出院。
LV 扩张是 VA ECMO 的已知并发症，会阻碍心脏的恢复。LAVA ECMO 提供了一种治疗 LV 扩张的新方法。此外，我们的回顾表明，这种方式可作为持久机械循环支持、心脏移植或恢复的桥梁。
