Femoral Veno-Arterial Extracorporeal Membrane Oxygenation using a novel
bi-atrial cannula for venous dranaige and left ventricular venting
Extracorporeal life support (ECLS) is an expanding technology for
patients in cardiogenic shock. Most patients requiring ECLS can be
managed with percutaneous veno-arterial (VA) femoral cannulation.
Despite sufficient extracorporeal circulatory support, an unclear number
of patients develop left ventricular distension which can result in
increased wall tension and stress as well as worsening pulmonary edema.
Indications to vent the left ventricle can be controversial. When
venting is indicated a number of additional procedures may be considered
including inotropic support, intra-aortic balloon pump, Impella, balloon
atrial septostomy, or placement of a transseptal cannula. We present a
unique case of a femoral VA Extracorporeal membrane oxygenation (ECMO)
as bridge to transplant (BTT) with left-sided venting using a
Bio-medicus NextGen cannula (Medtronic) with a transseptal approach.