Conventional venoarterial extracorporeal membrane oxygenation (VA-ECMO) places a functional afterload burden on the left ventricle. In the setting of acute severe aortic insufficiency-induced cardiogenic shock, the utility of VA-ECMO in combination with a failing valve may result in catastrophic haemodynamic consequences. This challenge is compounded when the culprit is a failing surgical bioprosthetic valve. We present a case of severe rapid-onset bioprosthetic aortic insufficiency-induced cardiogenic shock successfully resuscitated with left atrial VA-ECMO promptly followed by emergent percutaneous valve-in-valve transaortic valve replacement. We discuss the logistics, implications, and associated haemodynamic manifestations in utilizing this strategy for such disease processes.
Aortic Valve Insufficiency , Atrial Fibrillation , Extracorporeal Membrane Oxygenation , Transcatheter Aortic Valve Replacement , Humans , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Transcatheter Aortic Valve Replacement/adverse effects , Aortic Valve Insufficiency/complications , Aortic Valve Insufficiency/diagnosis
