PMID- 33965969
OWN - NLM
STAT- MEDLINE
DCOM- 20220321
LR  - 20230821
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 68
IP  - 3
DP  - 2022 Mar 1
TI  - Modified AngioVac System use With Extracorporeal Membrane Oxygenation in a Child 
      With Fontan Thrombosis.
PG  - e48-e52
LID - 10.1097/MAT.0000000000001429 [doi]
AB  - The AngioVac System (AVS) extracts venous and pulmonary artery (PA) thrombi. We 
      report modified use of the second-generation AVS with concurrent venoarterial 
      extracorporeal membrane oxygenation (VA-ECMO) in a 10-year-old, 23 kg patient 
      with failing Fontan circulation due to acute-on-chronic Fontan and PA thrombosis. 
      Emergent femoral VA-ECMO was initiated for profound hypoxemia during cardiac 
      catheterization. Fluoroscopy-guided thrombo-embolectomy was performed with AVS 
      components. A two-venous limb inflow cannulation strategy was used; the AngioVac 
      cannula (AVC) was positioned in the central PA and joined to the existing ECMO 
      venous-limb. Thrombus extraction proceeded by clamping the ECMO venous-limb with 
      the existing VA-ECMO centrifugal pump generating negative pressure to the AVC. 
      Extracorporeal membrane oxygenation arterial-limb access was used for blood 
      return. Settings to avoid cavitation were a maximal negative pressure of 100 mmHg 
      using <3500 RPMs. To access the branch PAs, the AVC was replaced by a 
      custom-modified 17 Fr arterial ECMO cannula. Clot retrieval was sufficient for 
      improved clinical status enabling ECMO discontinuation within 24-hours, and 
      discharge home 26-days later. This is the first description of successful 
      subtotal thrombo-embolectomy with AVS components in a child with Fontan 
      physiology concurrently supported on VA-ECMO, using one centrifugal pump. 
      Although feasible, circuit modifications and close monitoring are required to 
      avoid complications.
CI  - Copyright (c) ASAIO 2021.
FAU - Priest, John R
AU  - Priest JR
AD  - From the ECMO Program, Boston Children's Hospital, Boston, Massachusetts.
FAU - Brown, Mark
AU  - Brown M
AD  - From the ECMO Program, Boston Children's Hospital, Boston, Massachusetts.
FAU - Choi, Daniel
AU  - Choi D
AD  - From the ECMO Program, Boston Children's Hospital, Boston, Massachusetts.
FAU - Thiagarajan, Ravi
AU  - Thiagarajan R
AUID- ORCID: 0000-0002-4154-1693
AD  - Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
AD  - Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
FAU - Roy, Nathalie
AU  - Roy N
AUID- ORCID: 0000-0001-9977-5364
AD  - Department of Cardiac Surgery, Boston Children's Hospital, Boston Massachusetts.
AD  - Department of Surgery, Harvard Medical School, Boston MA.
FAU - Esch, Jesse
AU  - Esch J
AUID- ORCID: 0000-0002-4804-6660
AD  - Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
AD  - Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
FAU - Moynihan, Katie M
AU  - Moynihan KM
AUID- ORCID: 0000-0003-2515-2951
AD  - Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
AD  - Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
SB  - IM
MH  - Cannula
MH  - Cardiac Catheterization
MH  - Child
MH  - *Extracorporeal Membrane Oxygenation
MH  - Femoral Artery
MH  - Humans
MH  - *Thrombosis/etiology/therapy
COIS- Disclosure: The authors have no conflicts of interest to report.
EDAT- 2021/05/10 06:00
MHDA- 2022/03/22 06:00
CRDT- 2021/05/09 20:56
PHST- 2021/05/10 06:00 [pubmed]
PHST- 2022/03/22 06:00 [medline]
PHST- 2021/05/09 20:56 [entrez]
AID - 00002480-202203000-00025 [pii]
AID - 10.1097/MAT.0000000000001429 [doi]
PST - ppublish
SO  - ASAIO J. 2022 Mar 1;68(3):e48-e52. doi: 10.1097/MAT.0000000000001429.