26: When the Ventricle Needs a Vent: LAVA-ECMO as a Novel Strategy for LV Unloading in Cardiogenic Shock —A Retrospective Analysis from a Single Center

Background: During peripheral VA-ECMO, Left ventricular (LV) distension is a major challenge leading to high filling pressures and pulmonary congestion. The Left Atrial VA-ECMO (LAVA-ECMO) configuration offers a minimally invasive alternative for LV decompression by incorporating a transseptal drainage cannula connected to the ECMO circuit. We aimed to review the characteristics and outcomes of left atrial veno-arterial extra corporeal membrane oxygenation (LAVA ECMO) at our institution over a 6-month period from March to August 2025. Methods: This single centre retrospective observational analysis included six patients who received LAVA-ECMO as a LV unloading strategy while on peripheral VA-ECMO for acute coronary syndrome (n=1) and aluminium phosphide poisoning (n=5). Under fluoroscopy and echocardiographic guidance, a 23French multistage drainage cannula (Figure1) was introduced via transseptal puncture into the left atrium and connected to the ECMO drainage limb. Clinical parameters, echocardiographic findings, complications, and clinical outcomes were analyzed. Results (Table 1): LAVA-ECMO reduced pulmonary congestion and left ventricle blood stasis resulting in improvement in hemodynamics and oxygenation. 3 out of 6 patients showed significant recovery of LV function and were successfully weaned from ECMO. 3 patients with aluminium phosphide poisoning succumbed to refractory multi-organ dysfunction. Minor complications included mild hemolysis, arrhythmia, and cannulation-site bleeding, all managed conservatively. Major complications like embolic stroke, compartment syndrome, leg arterial thrombus (embolectomy done) were noted. Conclusion: LAVA-ECMO represents a safe, feasible, and effective minimally invasive approach for LV unloading in VA-ECMO patients with refractory LV distension. Early implementation in appropriate patients may improve outcomes in high-acuity settings such as cardiogenic and toxic shock. Clinical Significance: As surgical vents, intra-aortic balloon pump, Impella are technically demanding, costly, or associated with procedural risks, the LAVA-ECMO can be opted as a minimally invasive and physiologically effective strategy for LV unloading.