Staged Transition from V-A ECMO to LVAD Using Extra-VAD in Acute Myocardial Infarction Cardiogenic Shock: Individualized Management

Acute myocardial infarction(AMI) and cardiogenic shock (CS) in patients requiring veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is life-threatening, with extremely high mortality and complication rates due to hemodynamic instability and multiple organ dysfunction. A durable left ventricular assist device (LVAD) is a viable therapeutic option for these patients with severely impaired cardiac function who have failed attempts to wean from V-A ECMO. Right ventricular failure (RVF) is a significant cause of mortality in patients undergoing LVAD implantation. However, accurate assessment of right heart function during V-A ECMO and the complication rates associated with prolonged V-A ECMO support limit its long-term use. The interventional extracorporeal left ventricular assist device (extra-VAD) enables preoperative assessment by simulating the hemodynamic profile of a permanent LVAD, thereby helping to avoid complications associated with prolonged V-A ECMO support, bridging therapy decision-making and mitigating the risk of postoperative RVF after LVAD.