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Peer-reviewedCC BY-NC-ND 4.0Journal of the Society for Cardiovascular Angiography & Interventions

Utilization of Preventive Single-Inflow Cannula Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock

  • Yu-Tsung Shih1,2,3,4
  • Hung-Chang Jong1,2,3
  • Chia-Cheng Lin1,3
  • Bu-Yuan Hsiao3,4
  • Chung-Ming Tu5
  • Jung-Cheng Hsu5
  • Ta-Jung Wang1,2,3,4,5
5 affiliations
  1. 1Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
  2. 2Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  3. 3Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
  4. 4Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
  5. 5Division of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Abstract

Background: Left ventricular/left ventricle (LV) overload remains a major limitation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock. Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) has been proposed to facilitate LV unloading; however, data regarding its optimal timing and clinical role remain limited.

Methods: This single-center retrospective cohort study evaluated the efficacy and safety of a preventive single-inflow cannula LAVA-ECMO strategy, defined as an a priori LV unloading approach implemented at extracorporeal membrane oxygenation (ECMO) initiation, either through primary LAVA-ECMO implantation or planned early conversion from VA-ECMO within 60 minutes. Between January 2020 and July 2025, eligible patients supported with VA-ECMO or LAVA-ECMO were screened. After predefined exclusions, 42 patients managed with preventive LAVA-ECMO were compared with 64 contemporaneous patients receiving conventional VA-ECMO.

Results: Thirty-day all-cause mortality was lower in the LAVA-ECMO group than in the VA-ECMO group (47.6% vs 76.6%; adjusted hazard ratio, 0.54; 95% CI, 0.31-0.95). Failure to wean from ECMO tended to occur less frequently with LAVA-ECMO (31.0% vs 56.3%; adjusted odds ratio, 0.43; 95% CI, 0.18-1.01). Signs of LV overload during ECMO support were significantly reduced in the LAVA-ECMO group (47.6% vs 82.8%; adjusted odds ratio, 0.19, 95% CI, 0.08-0.49). Overall complication rates were comparable between groups.

Conclusions: In this retrospective cohort, preventive LAVA-ECMO was associated with lower short-term mortality and a reduced incidence of LV overload without an apparent increase in complications. Preventive LAVA-ECMO may represent a feasible mechanical circulatory support strategy in carefully selected patients with cardiogenic shock.

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Cite

BibTeXRIS
BibTeX
@article{shih2026utilization,
  title = {{Utilization of Preventive Single-Inflow Cannula Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock}},
  author = {Yu-Tsung Shih and Hung-Chang Jong and Chia-Cheng Lin and Bu-Yuan Hsiao and Chung-Ming Tu and Jung-Cheng Hsu and Ta-Jung Wang},
  journal = {Journal of the Society for Cardiovascular Angiography \& Interventions},
  year = {2026},
  month = sep,
  doi = {10.1016/j.jscai.2026.105518},
  url = {https://doi.org/10.1016/j.jscai.2026.105518},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Utilization of Preventive Single-Inflow Cannula Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock
AU  - Yu-Tsung Shih
AU  - Hung-Chang Jong
AU  - Chia-Cheng Lin
AU  - Bu-Yuan Hsiao
AU  - Chung-Ming Tu
AU  - Jung-Cheng Hsu
AU  - Ta-Jung Wang
PY  - 2026
DA  - 2026/09/10
JO  - Journal of the Society for Cardiovascular Angiography & Interventions
DO  - 10.1016/j.jscai.2026.105518
UR  - https://doi.org/10.1016/j.jscai.2026.105518
AB  - Background: Left ventricular/left ventricle (LV) overload remains a major limitation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock. Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) has been proposed to facilitate LV unloading; however, data regarding its optimal timing and clinical role remain limited.  Methods: This single-center retrospective cohort study evaluated the efficacy and safety of a preventive single-inflow cannula LAVA-ECMO strategy, defined as an a priori LV unloading approach implemented at extracorporeal membrane oxygenation (ECMO) initiation, either through primary LAVA-ECMO implantation or planned early conversion from VA-ECMO within 60 minutes. Between January 2020 and July 2025, eligible patients supported with VA-ECMO or LAVA-ECMO were screened. After predefined exclusions, 42 patients managed with preventive LAVA-ECMO were compared with 64 contemporaneous patients receiving conventional VA-ECMO.  Results: Thirty-day all-cause mortality was lower in the LAVA-ECMO group than in the VA-ECMO group (47.6% vs 76.6%; adjusted hazard ratio, 0.54; 95% CI, 0.31-0.95). Failure to wean from ECMO tended to occur less frequently with LAVA-ECMO (31.0% vs 56.3%; adjusted odds ratio, 0.43; 95% CI, 0.18-1.01). Signs of LV overload during ECMO support were significantly reduced in the LAVA-ECMO group (47.6% vs 82.8%; adjusted odds ratio, 0.19, 95% CI, 0.08-0.49). Overall complication rates were comparable between groups.  Conclusions: In this retrospective cohort, preventive LAVA-ECMO was associated with lower short-term mortality and a reduced incidence of LV overload without an apparent increase in complications. Preventive LAVA-ECMO may represent a feasible mechanical circulatory support strategy in carefully selected patients with cardiogenic shock.
SN  - 2772-9303
ER  -