Figure 2.

(A) IABP console during LV unloading with V-A-ECMO and iVAC2L. The diastolic pressure drop in the aortic pressure (green arrows) is attenuated as pressure increases in the gas chamber of iVAC2L (bottom waveform in blue). LV blood aspirated during systole is then ejected back in the ascending aorta. When the pressure falls in the gas chamber, ejection stops and aortic pressure quickly drops. The magnitude of the attenuation in the pressure drop may oscillate between successive beats due to transitory variations in myocardial conduction, mechanics and loading conditions generated by extra-systoles, arrhythmias or changes in intrathoracic pressure. (B) Aortography showing a watershed line around the left subclavian artery during 3.5 L/min V-A ECMO. (C) In the 5^th heart beat following iVAC2L activation, the watershed line moved to the descending aorta demonstrating a decrease in afterload despite V-A ECMO support. Red circle: two-way valve (outlet) positioned next to the coronary ostia; red arrow: distal tip if the iVAC system in the left ventricle; green arrow: pigtail catheter.