Related Experiment Video
Updated: Jan 10, 2026
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
Left Atrial Venting With Extracorporeal Support as a Bridge to Durable Support With Extensive Intracardiac Thrombus
Jean-Luc A Maigrot1, Ran Lee2, Laura Young2
1Department of Thoracic & Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Background:
Left ventricular thrombus complicating advanced cardiomyopathy poses challenges for mechanical circulatory support, especially when venting is required.
Case Summary:
The patient presented with anterolateral ST-segment elevation myocardial infarction from left ventricular thrombus embolization and underwent revascularization. He experienced arrest and was placed on venoarterial extracorporeal membrane oxygenation (ECMO). Extensive intracardiac thrombus contraindicated venting with a microaxial temporary left ventricular assist device (LVAD). Venoarterial ECMO was reconfigured to left atrial venoarterial ECMO (LAVA-ECMO), providing effective venting and hemodynamic support. Heart transplantation was deferred because of comorbidities. He was successfully bridged to high-risk durable LVAD implantation using meticulous surgical techniques.
Discussion:
LAVA-ECMO enabled safe and effective venting when other typical strategies were contraindicated. This facilitated hemodynamic stabilization and successful bridging to definitive therapy.
Take-Home Messages:
LAVA-ECMO offers an alternative for left atrial venting when other methods are contraindicated. Durable LVADs can be safe in patients with extensive intracardiac thrombus using careful surgical techniques.
