Background: Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) is a novel mechanical cardiocirculatory support strategy that provides robust cardiocirculatory support and simultaneous left and right atrial venting via a multi-fenestrated transeptal catheter.

Methods: This is a single-center retrospective analysis of all patients who underwent LAVA-ECMO at a quaternary care institution from 2018-2023. Clinical outcomes including pre- and post-hemodynamics were evaluated.

Results: A total of 68 patients were included (75% male, 72% white, median age 63). Indications for LAVA-ECMO were CS due to myocardial infarction (29.4%), biventricular failure (26.5%), and/or valvular heart disease (26.5%). Trans-septal puncture was guided by intracardiac echocardiography (86.8%) or transesophageal echocardiography (13.2%). Arterial cannulation was performed via transcaval access in 25% of the cases. Post-LAVA-ECMO cannulation was associated with substantial improvement in the hemodynamics within 24 hours post cannulation, including reduction in right atrial pressure (absolute mean difference: -5.0 mmHg, p<0.001), mean pulmonary artery pressure (-9.0 mmHg, p<0.001), pulmonary capillary wedge pressure (-10.0 mmHg, p<0.001), and LV end-diastolic pressure (-14.0 mmHg, p<0.001). Survival to decannulation occurred in 69.1%, while 30-day survival from cannulation was 51.5%. In-hospital all-cause mortality was 51.5%. Only 5 patients (7.4%) required additional MCS (4 Impella, 1 VAV-ECMO). There were no complications related to transeptal placement of the venous ECMO cannula.

Conclusion: LAVA-ECMO, a MCS strategy providing bi-atrial drainage and thus simultaneous LV venting, appears to be a feasible and efficacious treatment modality in select patients. Further studies are needed to evaluate the safety profile of LAVA-ECMO compared to alternative MCS strategies.