LAVA-ECMO–Supported Dual-Transcatheter Aortic and Mitral Valve-in-Valve Replacement in Cardiogenic Shock

Mechanical circulatory support is often challenging in patients with cardiogenic shock secondary to valvular heart disease because of challenging device placement, decreased efficacy, the need for a concomitant device for left ventricular unloading, or contraindications. Left atrial venoarterial-extracorporeal membranous oxygenation (LAVA-ECMO) is an emerging technique to achieve simultaneous ventricular unloading and circulatory support unaffected by valvular disease. The use of LAVA-ECMO for high-risk transcatheter valvular replacement has not been described. We describe the case of a patient with cardiogenic shock resulting from dual aortic and mitral bioprosthetic degeneration who was treated with LAVA-ECMO–supported dual-transcatheter aortic and mitral valve-in-valve replacement. Among many precautions worth mentioning, operators should be aware of the care and adjustments of the ECMO circuit required during transcatheter valvular replacement to achieve technical success without complications. The importance of a careful case planning in a multidisciplinary heart team meeting cannot be overemphasized. LAVA ECMO enables high-risk valvular replacement in patients in valvular cardiogenic shock. [Display omitted]