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A mini‐thoracotomy approach for walking veno‐arterial extracorporeal membranous oxygenation
Author(s) -
Jeng Eric I.,
Parker Alex M.,
Bleiweis Mark S.
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15232
Subject(s) - medicine , cardiogenic shock , myocarditis , extracorporeal membrane oxygenation , cardiology , impella , lethargy , surgery , fulminant , ascending aorta , aorta , myocardial infarction
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.