Fig. 1

Central extracorporeal life support system with left ventricular apex vent and pulmonary artery return. A central extracorporeal life support (ECLS) system can be established for patients with severe heart failure due to respiratory failure. The process begins with the introduction of a drainage cannula into the left ventricular apex and connection of the return cannula, which goes to the ascending aorta, to a centrifugal pump circuit equipped with an artificial lung. Given that drainage from the left ventricular apex is often insufficient to maintain total flow in such patients, a peripheral venous cannula is inserted via the femoral vein into the superior vena cava–right atrium (SVC-RA) junction. Subsequently, the cannula is connected to a left ventricular drainage cannula using a Y-connector. To prevent the formation of a left ventricular thrombus, another return cannula is placed into the main pulmonary artery when the drainage volume from the left ventricular apex is exceedingly low. The cannula is connected to the ascending aortic return cannula using a Y-connector. The balance of flow between the two cannulas is controlled by using an adjustable clamp and a separate flow sensor located on one of the outflow tubes