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A Mini-Thoracotomy Approach for Walking Veno-Arterial Extracorporeal Membranous Oxygenation
  • Eric Jeng,
  • Alex Parker,
  • Mark Bleiweis
Eric Jeng
University of Florida
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Alex Parker
University of Florida Health
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Mark Bleiweis
University of Florida COM
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Abstract

Fulminant myocarditis is a rapidly progressive myocardial inflammation that commonly requires advanced therapies circulatory support. We report our management for a case of fulminant myocarditis and cardiogenic shock. The patient is a 36 year old gentleman who was admitted after a one week history of malaise. Upon admission he was lethargic with jugular venous distension to 10 cm. He was taken immediately for a heart catheterization and intra-aortic balloon pump placement. There was no obstructive coronary disease, and hemodynamics were consistent with biventricular failure. After multidisciplinary evaluation, we elected to proceed with emergent extracorporeal membranous oxygenation (ECMO). We utilize a Protek Duo Rapid Deployment (LivaNova, Mirandola, Italy) which is inserted via modified Seldinger technique through the left ventricular apex, terminating in the ascending aorta. Percutaneous right IJ bicaval via a y-ed Avalon Elite (Getinge, Goteborg, Sweden) approach is employed for venous drainage (Figure 1). We believe that with this alternative ECMO cannulation platform, we address the multitude of drawbacks that plague peripherally cannulated extracorporeal circulatory support, minimizing patient deconditioning and upper/lower extremity over/under perfusion complications, while providing sternal sparring antegrade arterial flow with ventricular unloading/venting. For two weeks the patient was ambulatory, but because we were unable to obtain an adequate offer during this interval, we transitioned to a bridge to bridge therapy. This case highlights an alternate strategy for central walking VA ECMO in the rare presentation of one patient’s progression from IABP to VA ECMO to durable BiVAD to heart transplantation during a single admission.

Peer review status:ACCEPTED

01 Jun 2020Submitted to Journal of Cardiac Surgery
05 Jun 2020Submission Checks Completed
05 Jun 2020Assigned to Editor
29 Jun 2020Review(s) Completed, Editorial Evaluation Pending
29 Jun 2020Editorial Decision: Revise Minor
13 Jul 20201st Revision Received
16 Jul 2020Assigned to Editor
16 Jul 2020Submission Checks Completed
16 Jul 2020Review(s) Completed, Editorial Evaluation Pending
03 Aug 2020Editorial Decision: Revise Major
31 Aug 20202nd Revision Received
01 Sep 2020Submission Checks Completed
01 Sep 2020Assigned to Editor
01 Sep 2020Review(s) Completed, Editorial Evaluation Pending
21 Sep 2020Editorial Decision: Accept