Introduction: In cardiogenic shock, peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide hemodynamic support, however this results in adverse left ventricular afterload. Left ventricle (LV) venting (unloading) has favorable effects on myocardial remodeling and hemodynamics. The preferred approach at our institution is by adding left atrial drainage via trans-septal puncture, resulting in Bi-Atrial VV-A (BAVVA) ECMO. An advantage of BAVVA-ECMO is that it avoids the need for additional large bore arterial access. Here, we present our single center case-series on BAVVA-ECMO.

Methods: Adults cannulated for BAVVA-ECMO in our institution from 2011 – 2023. Baseline demographics including age, sex, race and BMI were examined. The primary outcome of interest was survival to recovery or transplant. Other outcomes of interest include bleeding, limb complications, renal replacement therapy and duration of ECMO support.

Results: There were 56 patients who underwent transseptal puncture for LA vent decompression at our institution. Baseline characteristics include a mean age of 53.1 ± 16.6, 37 (66.1%) male and a mean BMI 31.3 ± 5.7 (table 1). Patients were supported for a median of 10.6 [4.91, 15.9] days. Regarding complications 2 (3.6%) developed limb complications, 21 (37.5) required renal replacement therapy, and 13 (23.2%) experienced major bleeding. Regarding the primary outcome of interest, 28 (50%) survived to recovery or transplant.

Conclusion: LA transseptal venting for VA-ECMO is an alternative approach to left ventricular venting in cardiogenic shock that does not involve additional large bore arterial access. Further studies are needed to directly compare BAVVA-ECMO to other approaches in LV venting.