A mini‐thoracotomy approach for walking veno‐arterial extracorporeal membranous oxygenation

Fulminant myocarditis is a rapidly progressive myocardial inflammation that commonly requires advanced circulatory support therapies. We report our management of a 36‐year‐old gentleman with fulminant myocarditis who we managed with extracorporeal membranous oxygenation (ECMO) and subsequently durable bi‐ventricular assist devices as a bridge to heart transplantation. The patient was admitted after a 1‐week history of malaise with severe lethargy, jugular venous distension to greater than 10 cm, and troponin elevation to greater than 27 K. He was taken immediately for a heart catheterization which showed no obstructive coronary disease, and hemodynamics consistent with bi‐ventricular failure. We proceeded with ECMO for hemodynamic support, utilizing a mini‐thoracotomy for cannulation. A Protek Duo Rapid Deployment (LivaNova) was inserted via a modified Seldinger technique through the left ventricular apex, terminating in the ascending aorta. Percutaneous right IJ bicaval via a y‐ed Avalon Elite (Getinge) was employed for venous drainage. This case highlights an alternate strategy for central walking veno‐arterial ECMO in a patient presenting with fulminant myocarditis with a platform that minimizes upper/lower extremity over/under perfusion complications, while providing sternal sparring antegrade arterial flow with simultaneous ventricular unloading/venting.