Fang Jonathan X, Giustino Gennaro, Apostolou Dimitrios, Lee James C, Wang Dee Dee, Engel Gonzalez Pedro, O'Neill Brian P, Frisoli Tiberio M, O'Neill William W, Villablanca Pedro A
Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA.
Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
JACC Case Rep. 2024 Oct 2;29(19):102564. doi: 10.1016/j.jaccas.2024.102564.
Mechanical circulatory support is often challenging in patients with cardiogenic shock secondary to valvular heart disease because of challenging device placement, decreased efficacy, the need for a concomitant device for left ventricular unloading, or contraindications. Left atrial venoarterial-extracorporeal membranous oxygenation (LAVA-ECMO) is an emerging technique to achieve simultaneous ventricular unloading and circulatory support unaffected by valvular disease. The use of LAVA-ECMO for high-risk transcatheter valvular replacement has not been described.
We describe the case of a patient with cardiogenic shock resulting from dual aortic and mitral bioprosthetic degeneration who was treated with LAVA-ECMO-supported dual-transcatheter aortic and mitral valve-in-valve replacement.
Among many precautions worth mentioning, operators should be aware of the care and adjustments of the ECMO circuit required during transcatheter valvular replacement to achieve technical success without complications. The importance of a careful case planning in a multidisciplinary heart team meeting cannot be overemphasized.
TAKE-HOME MESSAGE: LAVA ECMO enables high-risk valvular replacement in patients in valvular cardiogenic shock.
对于继发于瓣膜性心脏病的心源性休克患者，机械循环支持往往具有挑战性，原因包括设备放置困难、疗效降低、需要同时使用左心室卸载设备或存在禁忌证。左心房静脉 - 动脉体外膜肺氧合（LAVA - ECMO）是一种新兴技术，可实现不受瓣膜疾病影响的同时心室卸载和循环支持。LAVA - ECMO在高危经导管瓣膜置换术中的应用尚未见报道。
我们描述了一例因主动脉和二尖瓣生物瓣双瓣退变导致心源性休克的患者，接受了LAVA - ECMO支持下的经导管主动脉和二尖瓣瓣中瓣置换术。
在众多值得提及的预防措施中，操作人员应注意经导管瓣膜置换期间所需的ECMO回路护理和调整，以实现技术成功且无并发症。在多学科心脏团队会议中进行仔细的病例规划的重要性再怎么强调也不为过。
LAVA - ECMO可使瓣膜性心源性休克患者进行高危瓣膜置换。
