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Article Abstract
Background: In hemodynamically unstable patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO), left ventricular unloading may be essential but technically challenging, especially after aortic valve replacement.
Case Summary: We report a case of a 64-year-old male patient with postcardiotomy cardiogenic shock after combined coronary and aortic valve surgery. VA-ECMO alone was insufficient, prompting the use of a microaxial flow pump via axillary access. Challenges included left ventricle wiring through the closed bioprosthetic aortic valve and navigating a severely stenotic subclavian artery. A combination of advanced imaging and vascular techniques enabled successful device placement.
Take-home Messages: A transesophageal ultrasound-guided mother-and-child technique with steerable catheter allows precise control for atraumatic valve crossing in case of functionally closed aortic leaflets. Intravascular lithotripsy is a potent tool to facilitate large-bore access for mechanical circulatory support in patients with calcified peripheral artery disease.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371350 | PMC |
| http://dx.doi.org/10.1016/j.jaccas.2025.104683 | DOI Listing |
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