A mini‐thoracotomy approach for walking veno‐arterial extracorporeal membranous oxygenation. Issue 4 (16th December 2020)

• Record Type: Journal Article
• Authors: Jeng, Eric I.; Parker, Alex M.; Bleiweis, Mark S.
• Is Part Of: Journal of cardiac surgery. Volume 36:Issue 4(2021)
• Page Start: 1569
• Page End: 1571
• Publication Date: 2020-12-16
• Subjects: perfusion -- transplant; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.15232
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: 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.