Prophylactic percutaneous circulatory support in high risk transcatheter aortic valve implantation
Mechanical circulatory support in transcatheter aortic valve implantation (TAVI) procedures is a useful solution for both planned and in emergent cases and provides prophylactic implantations which can subsequently avoid complications. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides both hemodynamic and oxygenation support. Percutaneous VA-ECMO can be inserted with fluoroscopy or ultrasound guidance. A perfusion cannula is required to protect against distal limb ischemia.
... l limb ischemia. VA-ECMO can either be used in prophylactic settings or as a rescue therapy     . Reported herein, is a prophylactic VA-ECMO paradigm case in a TAVI setting in order to illustrate the main steps. Also, a systematic search of all existing literature was performed from the main bibliographic databases (Pubmed, Medline, Google Scholar, and Cochrane). The case of a 63-year-old male patient with ischemic cardiomyopathy, severe left ventricular systolic dysfunction, dual-chamber implantable cardiac defibrillator and moderate aortic stenosis is presented. Two months prior to index admission, he developed chest pain and dyspnea at minimal exertion. A coronary angiogram revealed significant stenosis of the distal left main coronary artery including the origin of the descendent coronary artery and the circumflex and the echocardiogram showed a severe aortic stenosis (peak velocity of 3.2 m/s, peak and mean gradients of 40 and 23 mmHg respectively, estimated area of 0.9 cm 2 ), functional moderate mitral regurgitation with effective regurgitant orifice area of 0.3 cm 2 , and left ventricular ejection fraction (LVEF) of 22%.