Staged transition from veno-arterial extracorporeal membrane oxygenation to left ventricular assist device using Extra-VAD in acute myocardial infarction cardiogenic shock: a case report of individualized management.

BACKGROUND: Acute myocardial infarction (AMI) and cardiogenic shock (CS) in patients requiring veno-arterial extracorporeal membrane oxygenation (V-A ECMO) are 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. 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 MoyoAssist® 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 right ventricular failure (RVF) after LVAD. CASE DESCRIPTION: A 58-year-old male was diagnosed with AMI accompanied by CS requiring V-A ECMO and intra-aortic balloon pump (IABP) assistance. Due to low left ventricular ejection fraction (LVEF) and difficulty in weaning from V-A ECMO, the patient was transferred to our hospital via ambulance on day 14 after V-A ECMO assistance. Despite optimization of medical therapy for heart failure following admission, ventricular function remained poor. Moreover, the IABP was removed on day 18 because of abdominal pain and marked leukocytosis. Over time, the sequelae of extended V-A ECMO support became apparent, characterized by systemic inflammation, impaired multi-organ perfusion, and the emergence of typical device-related complications. In response to this deterioration, an interventional Extra-VAD was implanted on day 19. Following several days of Extra-VAD support, despite improvement in general condition and organ function, left ventricular function remained poor. Thus, on day 25, our team proceeded with definitive LVAD implantation and removal of the Extra-VAD. The patient was discharged with LVAD support on postoperative day 38 and transitioned to outpatient follow-up care. CONCLUSIONS: This case demonstrates a staged bridging strategy from V‑A ECMO and Extra‑VAD to definitive LVAD therapy for acute circulatory failure. This approach achieves hemodynamic stability and organ protection in critically ill patients with shock and multi‑organ injury, provides a crucial time window for subsequent treatment, and underscores the value of a staged, minimally invasive, and individualized mechanical circulatory support strategy.