59: Heart under pressure: Transforming LV Venting with catheter techniques

Introduction: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has become a well-established method for providing short-term mechanical support in patients experiencing severe, refractory cardiogenic shock. However, an often-overlooked aspect of VA-ECMO is its particularly concerning LV distension. VA-ECMO increases the afterload in the aorta, forcing the already compromised LV to pump against this elevated afterload. As a result, the LV may struggle to generate enough force to eject blood, leading to the aortic valve (AV) remaining closed. This situation can cause LV distension, which may further elevate pulmonary artery pressures, lead to pulmonary edema, and impede LV recovery. Case Presentation: A 41-year-old previously healthy male presented to emergency room with chest pain and was diagnosed with STEMI, leading to cardiac arrest. Return of spontaneous circulation (ROSC) was achieved after extracorporeal cardiopulmonary resuscitation but he experienced ventricular fibrillation. Following ECPR, he underwent catheterization with a drug-eluting stent placement and IABP insertion. Echocardiography revealed an ejection fraction of 5%. Right axillary artery access with 7Fr. and 45 cm long flexible, kink-resistant super Arrow-Flex sheath was connected to a minilung and drained into the VA-ECMO access cannula for LV venting. The patient faced multiple complications sepsis and multiorgan dysfunction, including AKI, acute liver injury. Despite intensive management, the patient remained unstable and couldn’t survived. Conclusions: Left ventricular (LV) distension is an increasingly recognized challenge during VA-ECMO support. We believe that direct venting is the most effective strategy for managing LV distension. We expect in future smaller devices for LV venting will be available, which could be utilized early in the course of VA-ECMO support.