26, 3, 11, 15
Heart Failure Association of the ESC clinical consensus statement. Temporary mechanical circulatory support section supplies: pre-implantation phenotyping by imaging (LV versus RV versus biventricular failure; left atrial dimensions guiding the choice between left atrial and left ventricular venting cannulas; intracardiac thrombi; mitral and tricuspid regurgitation; inferior vena cava dimensions; RV peak systolic pressures); aortic stenosis or regurgitation and intracardiac shunts as disorders affecting the feasibility of VA ECMO; aortic dissection as a contraindication. FOR VA ECMO, TOE CAN GUIDE POSITIONING OF THE INFLOW CANNULA TIP, WHICH SHOULD REMAIN FREE IN THE RIGHT ATRIUM, with final positions confirmed by echocardiography before leaving the catheterisation laboratory or operating room. Daily echocardiography, or more frequent checks during haemodynamic changes, monitors ventricular and valvular function, particularly aortic regurgitation, and assesses potential for weaning. When native function is not sufficiently recovered or flow is disproportionately high, expect spontaneous contrast in the LV, no or intermittent aortic valve opening, and thrombus in the aortic root; the escalation sequence is to reduce flow or add inotropes first, then an unloading device or atrial septostomy.
Certainty: consensus. Graded as consensus rather than evidence by the document itself.
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