Left Atrial Venting With Extracorporeal Support as a Bridge to Durable Support With Extensive Intracardiac Thrombus.

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.