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Brewer JM, Maybauer MO. The ProtekDuo Cannula: A Comprehensive Review of Efficacy and Clinical Applications in Right Ventricular Failure. J Clin Med 2024; 13:4077. [PMID: 39064117 PMCID: PMC11278424 DOI: 10.3390/jcm13144077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Right ventricular failure (RVF) is a clinical challenge associated with various underlying acute and chronic medical conditions, necessitating diverse management strategies including mechanical circulatory support (MCS). The ProtekDuo cannula represents an important advancement in medical devices for MCS in the setting of RVF. When combined with an extracorporeal blood pump, the dual-lumen design allows for direct bypass of the RV using simultaneous drainage and return of blood using percutaneous, single-site access. Studies have reported favorable outcomes with the ProtekDuo cannula and low device-related complications, but comparative studies with other MCS devices are limited. Still, the ProtekDuo cannula has numerous advantages; however, it is not without challenges, and opportunities for further research exist. The ProtekDuo cannula holds significant potential for future advancements in the field of MCS, offering promising solutions for RVF management.
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Affiliation(s)
- Joseph M. Brewer
- Specialty Critical Care and Acute Circulatory Support Service, Nazih Zuhdi Transplant Institute, INTEGRIS Health Baptist Medical Center, Oklahoma City, OK 73112, USA
| | - Marc O. Maybauer
- Division of Critical Care Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL 32610, USA
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, 35037 Marburg, Germany
- Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, QLD 4072, Australia
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2
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Lee SY, Ahn JH, Kim HC, Shim TS, Kang PJ, Lee GD, Choi SH, Jung SH, Park SI, Hong SB. Outcomes of Lung Transplantation in Patients With Right Ventricular Dysfunction: A Single-Center Retrospective Analysis Comparing ECMO Configurations in a Bridge-to-Transplant Setting. Transpl Int 2024; 37:12657. [PMID: 38845757 PMCID: PMC11153757 DOI: 10.3389/ti.2024.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024]
Abstract
This study aimed to assess the lung transplantation (LT) outcomes of patients with right ventricular dysfunction (RVD), focusing on the impact of various extracorporeal membrane oxygenation (ECMO) configurations. We included adult patients who underwent LT with ECMO as a bridge-to-transplant from 2011 to 2021 at a single center. Among patients with RVD (n = 67), veno-venous (V-V) ECMO was initially applied in 79% (53/67) and maintained until LT in 52% (35/67). Due to the worsening of RVD, the configuration was changed from V-V ECMO to veno-arterial (V-A) ECMO or a right ventricular assist device with an oxygenator (Oxy-RVAD) in 34% (18/67). They showed that lactic acid levels (2-6.1 mmol/L) and vasoactive inotropic score (6.6-22.6) increased. V-A ECMO or Oxy-RVAD was initiated and maintained until LT in 21% (14/67) of cases. There was no significant difference in the survival rates among the three configuration groups (V-V ECMO vs. configuration changed vs. V-A ECMO/Oxy-RVAD). Our findings suggest that the choice of ECMO configuration for LT candidates with RVD should be determined by the patient's current hemodynamic status. Vital sign stability supports the use of V-V ECMO, while increasing lactic acid levels and vasopressor needs may require a switch to V-A ECMO or Oxy-RVAD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sang-Bum Hong
- Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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3
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Brewer JM, Lorusso R, Broman LM, Conrad SA, Swol J, Maybauer MO. Central Venopulmonary Extracorporeal Membrane Oxygenation: Background and Standardized Nomenclature. ASAIO J 2024:00002480-990000000-00486. [PMID: 38768563 DOI: 10.1097/mat.0000000000002239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
This review highlights advancements in extracorporeal life support (ECLS), emphasizing the critical role of standardized terminology, particularly for extracorporeal membrane oxygenation (ECMO) in treating right ventricular and respiratory failure. Advocating for the adoption of the Extracorporeal Life Support Organization (ELSO) Maastricht Treaty for ECLS Nomenclature guidelines, it aims to resolve communication barriers in the ECMO field. Focusing on venopulmonary (VP) ECMO utilizing central pulmonary artery (PA) access, this review details surgical approaches and introduces a terminology guide to support effective knowledge exchange and advancements in patient care.
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Affiliation(s)
- J Michael Brewer
- From the Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
- Queen's University Health Quality Programs, Kingston, ON, Canada
| | - Roberto Lorusso
- Extracorporeal Life Support (ECLS) Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Center, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
- Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - L Mikael Broman
- Extracorporeal Membrane Oxygenation (ECMO) Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Steven A Conrad
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Marc O Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, Australia
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida, Gainesville, Florida
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4
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Yoo GY, Lee J, Hong SB, Kim DY. Percutaneous OxyRVAD in a Patient with Severe Respiratory Failure and Right Heart Failure: A Case Report. J Chest Surg 2024; 57:319-322. [PMID: 38225830 PMCID: PMC11089057 DOI: 10.5090/jcs.23.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 01/17/2024] Open
Abstract
Venovenous extracorporeal membrane oxygenation (VV ECMO) is often used in cases of severe respiratory failure, especially in patients considered for lung transplantation. However, because many lung diseases can ultimately result in right heart failure, the treatment of secondary right heart failure can present a challenge when the patient is already under VV ECMO support. In such cases, an oxygenated-right ventricular assist device (OxyRVAD) can be used. OxyRVAD is designed to maintain anterograde blood flow and prevent right ventricular distension. Moreover, the pulmonary arterial cannula can be inserted percutaneously. We report a case in which percutaneous OxyRVAD was successfully implemented to manage right heart failure in a patient with respiratory failure who was on VV ECMO.
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Affiliation(s)
- Ga Young Yoo
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - June Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Beom Hong
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Do Yeon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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5
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Thomas C, Tobes D, Trela K, Montes M, Cuppini C, Petty K, Saini G, Perdigao J, Song T, Dalton A, Tung A. A Case Report of Percutaneous Right Ventricular Assist Device Utilization After Cesarean Delivery in a Patient With Severe Pulmonary Arterial Hypertension. A A Pract 2023; 17:e01728. [PMID: 37975893 DOI: 10.1213/xaa.0000000000001728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Physiologic changes of pregnancy are poorly tolerated in patients with pulmonary arterial hypertension (PAH), and peripartum maternal mortality is high. We present a case of a 31-year-old G3P0020 patient at 35 weeks' gestation with severe World Health Organization group I PAH who underwent cesarean delivery followed by percutaneous right ventricular assist device placement. Risks and benefits of the mode of delivery, neuraxial versus general anesthesia, and mechanical circulatory support are reviewed.
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Affiliation(s)
- Caroline Thomas
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - Daniel Tobes
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - Kristin Trela
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - Mariana Montes
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - Candice Cuppini
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - Kyle Petty
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - Gurjit Saini
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - Joana Perdigao
- Department of Maternal and Fetal Medicine, University of Chicago, Chicago, Illinois
| | - Tae Song
- Department of Cardiac Surgery, University of Chicago, Chicago, Illinois
| | - Allison Dalton
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - Avery Tung
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
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6
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Percutaneous Pulmonary Artery Cannulation to Treat Acute Secondary Right Heart Failure While on Veno-venous Extracorporeal Membrane Oxygenation. ASAIO J 2022; 68:1483-1489. [PMID: 36469447 DOI: 10.1097/mat.0000000000001692] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Right heart failure (RHF) is a common, yet difficult to manage, complication of severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation (ECMO) that is associated with increased mortality. Reports of the use of percutaneous mechanical circulatory support devices for concurrent right heart and respiratory failure are limited. This series describes the percutaneous cannulation of the pulmonary artery for conversion from veno-venous to veno-pulmonary artery return ECMO in 21 patients who developed secondary RHF. All patients cannulated between May 2019 and September 2021 were included. Either a 19 or 21 French venous cannula was placed percutaneously into the pulmonary artery via the internal jugular or subclavian vein, providing a total of 821 days of support (median 23 [4-71] days per patient) with flows up to 6 L/min. Five patients underwent cannulation at the bedside, with the remainder performed in the cardiac catheterization laboratory. Pulmonary artery cannulation occurred after 12 [8.5-23.5] days of ECMO support. Vasoactive infusion requirements decreased significantly within 24 hours of pulmonary artery cannula placement (p = 0.0004). Nonetheless, 75% of these patients expired after a median of 12 [4-63] days of support, with three patients found to have had significant pericardial effusions peri-arrest. This cannulation technique may be an effective alternative to veno-arterial ECMO cannulation or the placement of a dual-lumen cannula for the treatment of RHF.
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7
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Beller JP, Mehaffey JH, Wegermann ZK, Grau-Sepulveda M, O'Brien SM, Brennan JM, Thourani V, Badhwar V, Pagani FD, Ailawadi G, Yarboro LT, Teman NR. Strategies for Mechanical Right Ventricular Support during Left Ventricular Assist Device Implant. Ann Thorac Surg 2021; 114:484-491. [PMID: 34843696 DOI: 10.1016/j.athoracsur.2021.10.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/20/2021] [Accepted: 10/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Refractory right ventricular failure at the time of left ventricular assist device implantation requires treatment with supplemental mechanical circulatory support. However, the optimal strategy for support remains unknown. METHODS All patients undergoing first time durable left ventricular assist device implantation with a contemporary device were selected from the national Society of Thoracic Surgeons Database (2011-2019). Patients requiring right ventricular assist device (RVAD) or venoarterial extracorporeal membrane oxygenation (VA-ECMO) were included in the analysis. Patients were stratified by RVAD or VA-ECMO and by timing of placement (intraoperative vs. postoperative). RESULTS 18,423 left ventricular assist device implants were identified, of which 940 (5.1%) required RVAD (n=750) or VA-ECMO (n=190) support. Patients receiving an RVAD more frequently had preoperative inotrope requirement (76% vs. 62%, p<0.01) and severe tricuspid regurgitation (20% vs. 13%, p<0.01). RVAD patients experienced lower rates of postoperative renal failure (40% vs. 51%, p=0.02) and limb ischemia (4% vs. 13%, p<0.01), as well as significantly less operative mortality (41% vs. 54%, p<0.01). After risk-adjustment with propensity score analysis, support with VA-ECMO was associated with a higher risk of mortality (Risk Ratio 1.46 [1.21-1.77], p<0.01) compared to patients receiving an RVAD. Importantly, institution of right ventricular support postoperatively was associated with higher mortality (1.43, p<0.01) compared to intraoperative initiation. CONCLUSIONS Patients with severe right ventricular failure in the setting of durable left ventricular assist device implantation may benefit from the use of RVAD over VA-ECMO. Regardless of the type of support, initiation at the index operation was associated with improved outcomes.
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Affiliation(s)
- Jared P Beller
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | | | | | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - J Matthew Brennan
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | | | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Center, Morgantown, West Virginia
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Leora T Yarboro
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Nicholas R Teman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
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8
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Joshi Y, Bories MC, Aissaoui N, Grinda JM, Bel A, Latremouille C, Jouan J. Percutaneous venopulmonary artery extracorporeal membrane oxygenation for right heart failure after left ventricular assist device insertion. Interact Cardiovasc Thorac Surg 2021; 33:978-985. [PMID: 34313320 DOI: 10.1093/icvts/ivab197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/24/2021] [Accepted: 06/13/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Right ventricular failure after left ventricular assist device (LVAD) insertion is associated with significant mortality and morbidity. Mechanical support options include right ventricular assist devices, venoarterial extracorporeal membrane oxygenation (ECMO) and venopulmonary artery ECMO, the latter often involving central cannulation. We sought to evaluate the feasibility and early outcomes of a truly percutaneous venopulmonary artery (pVPA) ECMO strategy, with the potential advantage of bedside removal once weaned. METHODS Data from a single tertiary centre were reviewed retrospectively from January 2014 to January 2019. During this time, 54 patients underwent LVAD insertion, with 19 requiring mechanical support for right ventricular failure. Among them, 10 patients received pVPA ECMO. Implantation of the pVPA ECMO was performed under transoesophageal echocardiography and fluoroscopy guidance, with an inflow cannula placed in the right atrium via the right femoral vein and an outflow cannula placed in the left pulmonary artery (PA) via the right internal jugular vein. RESULTS Cannula insertion was 100% successful with no need for repositioning. Eight patients (80%) were able to be successfully weaned (at the bedside); 6 were discharged from the hospital and there were no cases of early sepsis, mediastinitis or thromboembolism. At follow-up, 5 patients had received transplants (50%), with 1 on LVAD support as destination therapy (10%). Survival was 60 ± 15% and 50 ± 16% at 6 and 12 months, respectively. CONCLUSIONS pVPA ECMO is 100% technically feasible and is an efficient method for temporary right ventricular support after LVAD insertion with the advantage of simple bedside removal and avoidance of a PA graft remnant in the chest cavity.
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Affiliation(s)
- Yashutosh Joshi
- St Vincent's Hospital, Sydney, NSW, Australia.,Western Sydney University, Blacktown Clinical School, Sydney, NSW, Australia.,St Vincent's Clinical School UNSW, Sydney, NSW, Australia
| | - Marie-Cecile Bories
- Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nadia Aissaoui
- Hôpital Européen Georges Pompidou, Service de Réanimation médicale, Assistance Publique Hôpitaux de Paris, Paris, France.,Université Paris-Descartes, Paris, France
| | - Jean-Michel Grinda
- Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alain Bel
- Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christian Latremouille
- Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Assistance Publique Hôpitaux de Paris, Paris, France.,Université Paris-Descartes, Paris, France
| | - Jérôme Jouan
- Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Assistance Publique Hôpitaux de Paris, Paris, France.,Université Paris-Descartes, Paris, France
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Natanov R, Ricklefs M, Madrahimov N, Fleissner F, Haverich A, Kühn C. Minimal invasive temporary percutaneous right ventricular circulatory support after left ventricular assist device implantation. Interact Cardiovasc Thorac Surg 2021; 33:795-800. [PMID: 34270709 DOI: 10.1093/icvts/ivab167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Cardiogenic shock is a life-threatening situation with high mortality rates. Mechanical unloading of the left ventricle may be achieved via left ventricular assist device (LVAD) implantation. Postoperative right ventricular (RV) failure, however, has very limited therapeutic options and is associated with increased postoperative mortality. In this paper, we describe a percutaneous right heart bypass for temporary postoperative RV support. METHODS We retrospectively examined all patients receiving percutaneous RV mechanical support after LVAD implantation. All patients receiving trans-jugular mechanical right heart bypass during or after LVAD implantation in our tertiary medical centre between November 2014 and December 2019 were examined retrospectively. The venous draining cannula was placed in the femoral vein; the pulmonary cannula was placed in the pulmonary artery using fluoroscopy. RESULTS In total, 14 patients received RV support using the trans-jugular technique. Mean age was 48.4 ± 14.9 years. Nine patients were treated with mechanical circulatory support before LVAD implantation. Biventricular support was done in 7 patients. All patients were treated with an HVAD. Mean postoperative intensive care unit stay was 46.3 ± 32.4 days. Mean right heart bypass support time was 10.6 ± 4.3 days. Twelve patients (86%) could be bridged to RV recovery, RV assist device implantation or heart transplantation. CONCLUSIONS Percutaneous RV mechanical support is feasible, safe and shows acceptable outcome. Early implantation of RV support may contribute to successful outcome after LVAD implantation.
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Affiliation(s)
- Ruslan Natanov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Marcel Ricklefs
- Department of Cardiology, KRH Klinikum Siloah, Hannover, Germany
| | - Nodir Madrahimov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Wamala I, Payne CJ, Saeed MY, Bautista-Salinas D, Van Story D, Thalhofer T, Staffa SJ, Ghelani SJ, Del Nido PJ, Walsh CJ, Vasilyev NV. Importance of Preserved Tricuspid Valve Function for Effective Soft Robotic Augmentation of the Right Ventricle in Cases of Elevated Pulmonary Artery Pressure. Cardiovasc Eng Technol 2021; 13:120-128. [PMID: 34263419 PMCID: PMC8888489 DOI: 10.1007/s13239-021-00562-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
Purpose In clinical practice, many patients with right heart failure (RHF) have elevated pulmonary artery pressures and increased afterload on the right ventricle (RV). In this study, we evaluated the feasibility of RV augmentation using a soft robotic right ventricular assist device (SRVAD), in cases of increased RV afterload. Methods In nine Yorkshire swine of 65–80 kg, a pulmonary artery band was placed to cause RHF and maintained in place to simulate an ongoing elevated afterload on the RV. The SRVAD was actuated in synchrony with the ventricle to augment native RV output for up to one hour. Hemodynamic parameters during SRVAD actuation were compared to baseline and RHF levels. Results Median RV cardiac index (CI) was 1.43 (IQR, 1.37–1.80) L/min/m2 and 1.26 (IQR 1.05–1.57) L/min/m2 at first and second baseline. Upon PA banding RV CI fell to a median of 0.79 (IQR 0.63–1.04) L/min/m2. Device actuation improved RV CI to a median of 0.87 (IQR 0.78–1.01), 0.85 (IQR 0.64–1.59) and 1.11 (IQR 0.67–1.48) L/min/m2 at 5 min (p = 0.114), 30 min (p = 0.013) and 60 (p = 0.033) minutes respectively. Statistical GEE analysis showed that lower grade of tricuspid regurgitation at time of RHF (p = 0.046), a lower diastolic pressure at RHF (p = 0.019) and lower mean arterial pressure at RHF (p = 0.024) were significantly associated with higher SRVAD effectiveness. Conclusions Short-term augmentation of RV function using SRVAD is feasible even in cases of elevated RV afterload. Moderate or severe tricuspid regurgitation were associated with reduced device effectiveness. Supplementary Information The online version contains supplementary material available at 10.1007/s13239-021-00562-7
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Affiliation(s)
- Isaac Wamala
- Department of Cardiac Surgery, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. .,Clinic for Cardiovascular Surgery, Charité Universitätsmedizin, Berlin, Germany.
| | - Christopher J Payne
- Wyss Institute for Biologically Inspired Engineering, Boston, USA.,Harvard School of Engineering and Applied Sciences, Boston, USA
| | - Mossab Y Saeed
- Department of Cardiac Surgery, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Daniel Bautista-Salinas
- Department of Cardiac Surgery, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Industrial Engineering, Technical University of Cartagena, Murcia, Spain
| | - David Van Story
- Department of Cardiac Surgery, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | | | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, USA
| | - Sunil J Ghelani
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Conor J Walsh
- Wyss Institute for Biologically Inspired Engineering, Boston, USA.,Harvard School of Engineering and Applied Sciences, Boston, USA
| | - Nikolay V Vasilyev
- Department of Cardiac Surgery, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
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11
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Lee JG, Pak C, Oh DK, Kim HC, Kang PJ, Lee GD, Choi SH, Jung SH, Hong SB. Right Ventricular Assist Device With Extracorporeal Membrane Oxygenation for Bridging Right Ventricular Heart Failure to Lung Transplantation: A Single-Center Case Series and Literature Review. J Cardiothorac Vasc Anesth 2021; 36:1686-1693. [PMID: 34344596 DOI: 10.1053/j.jvca.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Right ventricular heart failure (RVHF) is a critical complication in patients with respiratory failure, particularly among those who transitioned to lung transplantation using venovenous (VV) extracorporeal membrane oxygenation (ECMO). In these patients, both cardiac and respiratory functions are supported using venoarterial or venoarterial-venous ECMO. However, these modalities increase the risk of device-related complications, such as thromboembolism, bleeding, and limb ischemia, and they may disturb early rehabilitation. Due to these limitations, a right ventricular assist device with an oxygenator (Oxy-RVAD) using ECMO may be considered for patients with RVHF with VV ECMO. DESIGN A retrospective case series and literature review. SETTING A single tertiary care university hospital. PARTICIPANTS The study comprised lung transplantation candidates on ECMO bridging who developed right-sided heart failure. INTERVENTIONS An RVAD with ECMO. MEASUREMENTS AND MAIN RESULTS Of eight patients who underwent the study protocol, seven were bridged successfully to lung transplantation (BTT), and all patients with BTT were discharged, with a 30-day survival rate of 100% (7/7 patients). The 180-day survival rate was 85% (6/7 patients). CONCLUSIONS The study suggested that Oxy-RVAD using ECMO may be a viable option for bridging patients with RVHF to lung transplantation. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Jae Guk Lee
- Department of Pulmonary and Critical Care, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chuiyong Pak
- Department of Pulmonary and Critical Care, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Cheol Kim
- Department of Pulmonary and Critical Care, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Pil-Je Kang
- Thoracic and Cardiovascular Surgery Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Geun Dong Lee
- Thoracic and Cardiovascular Surgery Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Se Hoon Choi
- Thoracic and Cardiovascular Surgery Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Ho Jung
- Thoracic and Cardiovascular Surgery Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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12
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Nowacka A, Hullin R, Tozzi P, Barras N, Regamey J, Yerly P, Rosner L, Marcucci C, Rusca M, Liaudet L, Kirsch M. Short-term single-centre experience with the HeartMate 3 left ventricular assist device for advanced heart failure. Eur J Cardiothorac Surg 2021; 58:511-518. [PMID: 32236472 DOI: 10.1093/ejcts/ezaa075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/24/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The objective of this study was to analyse clinical characteristics, survival and adverse events of patients with advanced heart failure supported using the Abbott HeartMate 3 left ventricular assist device (LVAD). METHODS We retrospectively reviewed 42 consecutive HeartMate 3 recipients implanted in our centre between 1 November 2015 and 31 October 2019. RESULTS Our series comprised 39 males, aged 56.7 ± 11.8 years. Eleven (26%) patients had preimplant INTERMACS clinical profiles of 1 or 2. The mean duration support was 14.0 ± 10.6 months (range 0.69-44 months). During follow-up, 4 (10%) patients died while on support, 13 (35%) patients received a heart transplant and 25 patients are still ongoing. Actuarial survival after LVAD implantation was 88.4 ± 5.5% and 84.4 ± 6.6% at 1 and 2 years, respectively. There were no cases of pump thrombosis or technical malfunction. Seven (17%) patients required post-implant temporary right ventricular support. Adverse events included bleeding requiring surgery in 13 (31%) patients, gastrointestinal bleeding in 6 (14%) patients, LVAD-specific infections in 19 (45%) patients and non-disabling ischaemic stroke in 5 (12%) patients. The incidence of ischaemic stroke was significantly higher in patients where the outflow graft was anastomosed to the descending aorta as compared to those where it was anastomosed to the ascending aorta (P < 0.003). CONCLUSIONS We have observed satisfactory survival rates using the HeartMate 3 LVAD for long-term mechanical circulatory support. The absence of technical failure, pump thrombosis, haemolysis or need for pump exchange during our 4-year experience confirms its technical reliability and improved haemocompatibility, but bleeding complications and infections remain a concern.
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Affiliation(s)
- Anna Nowacka
- Department of Cardiac Surgery, University Hospital, Lausanne, Switzerland
| | - Roger Hullin
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Department of Cardiac Surgery, University Hospital, Lausanne, Switzerland
| | - Nicolas Barras
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | - Julien Regamey
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | - Patrick Yerly
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | - Lorenzo Rosner
- Department of Anaesthesiology, University Hospital, Lausanne, Switzerland
| | - Carlos Marcucci
- Department of Anaesthesiology, University Hospital, Lausanne, Switzerland
| | - Marco Rusca
- Department of Intensive Care Medicine, University Hospital, Lausanne, Switzerland
| | - Lucas Liaudet
- Department of Intensive Care Medicine, University Hospital, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, University Hospital, Lausanne, Switzerland
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13
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Lo Coco V, De Piero ME, Massimi G, Chiarini G, Raffa GM, Kowalewski M, Maessen J, Lorusso R. Right ventricular failure after left ventricular assist device implantation: a review of the literature. J Thorac Dis 2021; 13:1256-1269. [PMID: 33717597 PMCID: PMC7947472 DOI: 10.21037/jtd-20-2228] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation remains a major complication which may significantly impair patient outcome. The genesis of RVF is, however, multifactorial, and the mechanisms underlying such a condition have not been fully elucidated, making its prevention challenging and the course not always predictable. Although preoperative risks factors can be associated with RV impairment, the physiologic changes after the LV support, can still hamper the function of the RV. Current medical treatment options are limited and sometimes, patients with a severe post-LVAD RVF may be unresponsive to pharmacological therapy and require more aggressive treatment, such as temporary RV support. We retrieved 11 publications which we assessed and divided in groups based on the RV support [extracorporeal membrane oxygenation (ECMO), right ventricular assist device (RVAD), TandemHeart with ProtekDuo cannula]. The current review comprehensively summarizes the main studies of the literature with particular attention to the RV physiology and its changes after the LVAD implantation, the predictors and prognostic score as well as the different modalities of temporary mechanical cardio-circulatory support, and its effects on patient prognosis for RVF in such a setting. In addition, it provides a decision making of the pre-, intra and post-operative management in high- and moderate- risk patients.
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Affiliation(s)
- Valeria Lo Coco
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Maria Elena De Piero
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Anesthesia/Intensive Care, San Giovanni, Turin, Italy
| | - Giulio Massimi
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Cardiac Surgery, Circolo Hospital, University of Insurbia, Varese, Italy
| | - Giovanni Chiarini
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Division of Anesthesiology, Intensive Care and Emergency medicine, Spedali Civili University, Brescia, Italy
| | - Giuseppe M Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Mariusz Kowalewski
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Jos Maessen
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
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14
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Hamdan R, Charif F, Kadri Z. Right ventricle failure in patients treated with left ventricular assist device. Ann Cardiol Angeiol (Paris) 2020; 69:51-54. [PMID: 32127195 DOI: 10.1016/j.ancard.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/16/2020] [Indexed: 11/28/2022]
Abstract
This review article aim to highlight the right ventricular function peri left ventricular assist device implantation, and to assess the incidence, physiopathology, predictors, management and prognosis, of right ventricular failure post-implant.
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Affiliation(s)
- R Hamdan
- Cardiology department, Beirut Cardiac Institute, Beirut, Lebanon.
| | - F Charif
- Pneumology, Beirut Cardiac Institute, Beirut, Lebanon
| | - Z Kadri
- Cardiology department, Hôtel-Dieu de France, Beirut , Lebanon
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15
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Potapov EV, Antonides C, Crespo-Leiro MG, Combes A, Färber G, Hannan MM, Kukucka M, de Jonge N, Loforte A, Lund LH, Mohacsi P, Morshuis M, Netuka I, Özbaran M, Pappalardo F, Scandroglio AM, Schweiger M, Tsui S, Zimpfer D, Gustafsson F. 2019 EACTS Expert Consensus on long-term mechanical circulatory support. Eur J Cardiothorac Surg 2019; 56:230-270. [PMID: 31100109 PMCID: PMC6640909 DOI: 10.1093/ejcts/ezz098] [Citation(s) in RCA: 237] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many-sometimes contradictory-observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.
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Affiliation(s)
- Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Christiaan Antonides
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maria G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC, La Coruña, Spain
| | - Alain Combes
- Sorbonne Université, INSERM, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de médecine intensive-réanimation, Institut de Cardiologie, APHP, Hôpital Pitié–Salpêtrière, Paris, France
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Margaret M Hannan
- Department of Medical Microbiology, University College of Dublin, Dublin, Ireland
| | - Marian Kukucka
- Department of Anaesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Antonio Loforte
- Department of Cardiothoracic, S. Orsola Hospital, Transplantation and Vascular Surgery, University of Bologna, Bologna, Italy
| | - Lars H Lund
- Department of Medicine Karolinska Institute, Heart and Vascular Theme, Karolinska University Hospital, Solna, Sweden
| | - Paul Mohacsi
- Department of Cardiovascular Surgery Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Ege University, Izmir, Turkey
| | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, Cardiac Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Zurich Children's Hospital, Zurich, Switzerland
| | - Steven Tsui
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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16
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Shimada S, Nawata K, Kinoshita O, Ono M. Mechanical circulatory support for the right ventricle in combination with a left ventricular assist device. Expert Rev Med Devices 2019; 16:663-673. [PMID: 31216915 DOI: 10.1080/17434440.2019.1635006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Right heart failure (RHF) in patients with a left ventricular assist device (LVAD) carries a poor prognosis although the treatment strategy including mechanical circulatory support for the failing right ventricle (RV) has not been well established. Areas covered: In this review, we describe an overview of RHF post-LVAD implant including natural history, prevalence, pathophysiology, outcomes, and challenges to predict RHF post-LVAD implant. Then, we focus on right ventricular assist devices (RVADs) and their clinical outcomes. Recently developed percutaneous RVADs are the major advance in this field. Finally, we discuss future perspectives to overcome limitations of the current treatment options. Expert opinion: In the absence of dedicated RVAD system RHF post-LVAD implant may have been undertreated. Now that dedicated percutaneous RVADs have emerged, surgeons are encouraged to use these new devices to improve outcomes of LVAD therapy. As experience accumulates, we should be able to establish the best possible strategy to treat early RHF post-LVAD implant. Late RHF is another form of RHF post-LVAD implant and has been underappreciated. Further research is mandatory to clarify the mechanism and risk factors. There are still unmet needs for a dedicated implantable RVAD for a subset of patients who need long-term RV support.
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Affiliation(s)
- Shogo Shimada
- a Department of Cardiac Surgery, The University of Tokyo Hospital , Tokyo , Japan
| | - Kan Nawata
- a Department of Cardiac Surgery, The University of Tokyo Hospital , Tokyo , Japan
| | - Osamu Kinoshita
- a Department of Cardiac Surgery, The University of Tokyo Hospital , Tokyo , Japan
| | - Minoru Ono
- a Department of Cardiac Surgery, The University of Tokyo Hospital , Tokyo , Japan
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17
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Disfunción ventricular derecha acompañada de insuficiencia respiratoria grave. Opciones terapéuticas con dispositivos de asistencia mecánica. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Oh DK, Shim TS, Jo KW, Park SI, Kim DK, Choi S, Lee GD, Jung SH, Kang PJ, Hong SB. Right ventricular assist device with an oxygenator using extracorporeal membrane oxygenation as a bridge to lung transplantation in a patient with severe respiratory failure and right heart decompensation. Acute Crit Care 2019; 35:117-121. [PMID: 31743636 PMCID: PMC7280790 DOI: 10.4266/acc.2018.00416] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 02/26/2019] [Indexed: 11/30/2022] Open
Abstract
Right heart decompensation is a fatal complication in patients with respiratory failure, particularly in those transitioned to lung transplantation using veno-venous extracorporeal membrane oxygenation (V-V ECMO). In these patients, veno-arterial (V-A ECMO) or veno-arterialvenous extracorporeal membrane oxygenation (V-AV ECMO) is used to support both cardiac and respiratory function. However, these processes may increase the risk of device-related complications such as bleeding, thromboembolism, and limb ischemia. In the present case, a 64-year-old male patient with idiopathic pulmonary fibrosis developed respiratory failure and commenced treatment with V-V ECMO as a bridge to lung transplantation. Unfortunately, the patient developed right heart decompensation and required both cardiac and respiratory support during treatment with V-V ECMO. Instead of adding arterial cannulation, he was switched to a novel configuration, a right ventricular assist device with an oxygenator (Oxy- RVAD) using ECMO, with drainage cannulation from the femoral vein and return cannulation to the main pulmonary artery. The patient was successfully bridged to lung transplantation without serious complications after 10 days of Oxy-RVAD support. To the best of our knowledge, this is an extreme rare and challenging case of Oxy-RVAD using ECMO in a patient successfully bridged to lung transplantation.
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Affiliation(s)
- Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Sun Shim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Wook Jo
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pil-Je Kang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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19
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Hill GED, Traudt RJ, Durham LA, Pagel PS, Tawil JN. Successful Treatment of Refractory Status Asthmaticus Accompanied by Right Ventricular Dysfunction Using a Protek Duo Tandem Heart Device. J Cardiothorac Vasc Anesth 2019; 33:3085-3089. [PMID: 31076305 DOI: 10.1053/j.jvca.2019.03.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Graham E D Hill
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Ryan J Traudt
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Lucian A Durham
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Justin N Tawil
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
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20
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Riebandt J, Moayedifar R, Laufer G, Zimpfer D. Extracorporeal membrane oxygenation for right ventricular support in left ventricular assist device recipients. Ann Cardiothorac Surg 2019; 8:170-172. [PMID: 30854329 DOI: 10.21037/acs.2018.10.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Julia Riebandt
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Roxana Moayedifar
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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21
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Abstract
Right ventricular failure following left ventricular assist devices implantation is a serious complication associated with high mortality. In patients with or at high risk of developing right ventricular failure, biventricular support is recommended. Because univentricular support is associated with high survival rates, biventricular support is often undertaken as a last resort. With the advent of newer right ventricular and biventricular systems under design and testing, better differentiation is required to ensure optimal patients care. Clear guidelines on patient selection, time of intervention and device selection are required to improve patient outcomes.
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Affiliation(s)
- Sajad Shehab
- Cardiology Department, St Vincent's Hospital Sydney, Australia
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22
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Riebandt J, Haberl T, Wiedemann D, Moayedifar R, Schloeglhofer T, Mahr S, Dimitrov K, Angleitner P, Laufer G, Zimpfer D. Extracorporeal membrane oxygenation support for right ventricular failure after left ventricular assist device implantation. Eur J Cardiothorac Surg 2019; 53:590-595. [PMID: 29045747 DOI: 10.1093/ejcts/ezx349] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/30/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Right ventricular (RV) failure complicating left ventricular assist device implantation is associated with increased mortality. Despite a lack of supporting evidence, venoarterial extracorporeal membrane oxygenation (ECMO) support is increasingly being used as an alternative to traditional temporary RV support. We report our institutional experience with ECMO-facilitated RV support after left ventricular assist device implantation. METHODS We retrospectively reviewed the concept of temporary ECMO support for perioperative RV failure in 32 consecutive left ventricular assist device (mean age 52 ± 14 years; male 84.4%; ischaemic cardiomyopathy 40.6%; INTERMACS Level I 71.8%; INTERMACS Level II 6.3%; INTERMACS Level III 12.5%; INTERMACS Level IV-VII 9.4%; HeartWare ventricular assist device 75%; HeartMate II: 25%) from May 2009 to April 2014. The study end points were RV recovery during ECMO support, mortality and causes of death. RESULTS Twenty-nine (90.6%) patients were successfully weaned from ECMO support after RV recovery. Three (9.4%) patients expired during ECMO support. ECMO support improved RV function and haemodynamic parameters (central venous pressure 13 mmHg vs 10 mmHg, P < 0.01; mean pulmonary artery pressure 28 mmHg vs 21 mmHg, P < 0.01; cardiac output 5.1 l/min vs 5.9 l/min, P = 0.09) over a median period of 3 (range 1-15) days. Thirty-day and in-hospital mortality were 18.8% and 25%, respectively. One-year survival was 75%, causes of death were multiorgan dysfunction syndrome (50%), sepsis (25%), haemorrhagic stroke (12.5%) and ischaemic stroke (12.5%). Causes of death during ECMO support were ischaemic stroke, sepsis and multiorgan dysfunction syndrome. CONCLUSIONS Temporary ECMO-facilitated RV support is associated with good long-term outcomes and high rates of RV recovery.
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Affiliation(s)
- Julia Riebandt
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Thomas Haberl
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - R Moayedifar
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Thomas Schloeglhofer
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Stéphane Mahr
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Kamen Dimitrov
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Philipp Angleitner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
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23
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Dandel M, Hetzer R. Temporary assist device support for the right ventricle: pre-implant and post-implant challenges. Heart Fail Rev 2019; 23:157-171. [PMID: 29453695 DOI: 10.1007/s10741-018-9678-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Severe right ventricular (RV) failure is more likely reversible than similar magnitudes of left ventricular (LV) failure and, because reversal of both adaptive remodeling and impaired contractility require most often only short periods of support, the use of temporary RV assist devices (t-RVADs) can be a life-saving therapy option for many patients. Although increased experience with t-RVADs and progresses made in the development of safer devices with lower risk for complications has improved both recovery rate of RV function and patient survival, the mortality of t-RVAD recipients can still be high but it depends mainly on the primary cause of RV failure (RVF), the severity of end-organ dysfunction, and the timing of RVAD implantation, and much less on adverse events and complications related to RVAD implantation, support, or removal. Reduced survival of RVAD recipients should therefore not discourage appropriate application of RVADs because their underuse further reduces the chances for RV recovery and patient survival. The article reviews and discusses the challenges related to the pre-implant and post-implant decision-making processes aiming to get best possible therapeutic results. Special attention is focused on pre-implant RV assessment and prediction of RV improvement during mechanical unloading, patient selection for t-RVAD therapy, assessment of unloading-promoted RV recovery, and prediction of its stability after RVAD removal. Particular consideration is also given to prediction of RVF after LVAD implantation which is usually hampered by the complex interactions between the different risk factors related indirectly or directly to the RV potential for reverse remodeling and functional recovery.
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Affiliation(s)
- Michael Dandel
- DZHK (German Centre for Heart and Circulatory Research), Partner site Berlin, Berlin, Germany. .,Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Roland Hetzer
- Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Cardio Centrum Berlin, Berlin, Germany
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24
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Liberal Right Ventricular Assist Device Extracorporeal Membrane Oxygenation Support for Right Ventricular Failure after Implantable Left Ventricular Assist Device Placement. ASAIO J 2018; 64:741-747. [DOI: 10.1097/mat.0000000000000735] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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25
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Pieri M, Pappalardo F. Impella RP in the Treatment of Right Ventricular Failure: What We Know and Where We Go. J Cardiothorac Vasc Anesth 2018; 32:2339-2343. [DOI: 10.1053/j.jvca.2018.06.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 12/21/2022]
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26
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Koller T, Miralles Bagán J, Durán-Cambra A, Mirabet Pérez S, Tauron Ferrer M, Galán Serrano J. Severe Combined Right Ventricular and Respiratory Failure. Treatment Options With Mechanical Assist Devices. ACTA ACUST UNITED AC 2018; 72:504-505. [PMID: 29884585 DOI: 10.1016/j.rec.2018.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Tobias Koller
- Departamento de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Jordi Miralles Bagán
- Departamento de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Albert Durán-Cambra
- Departamento de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sonia Mirabet Pérez
- Departamento de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Manel Tauron Ferrer
- Departamento de Cirugía Cardiaca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Josefina Galán Serrano
- Departamento de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Givens RC, Topkara VK. Renal risk stratification in left ventricular assist device therapy. Expert Rev Med Devices 2017; 15:27-33. [DOI: 10.1080/17434440.2018.1418663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Raymond C. Givens
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Veli K. Topkara
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
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Outcomes of Minimally Invasive Temporary Right Ventricular Assist Device Support for Acute Right Ventricular Failure During Minimally Invasive Left Ventricular Assist Device Implantation. ASAIO J 2017; 63:546-550. [DOI: 10.1097/mat.0000000000000526] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kimmaliardjuk DM, Ruel M. Cardiac passive-aggressive behavior? The right ventricle in patients with a left ventricular assist device. Expert Rev Cardiovasc Ther 2017; 15:267-276. [PMID: 28306362 DOI: 10.1080/14779072.2017.1308252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Right ventricular failure (RVF) affects up to 50% of patients post-left ventricular assist device (LVAD) implantation, and carries significant morbidity and mortality. There is no widely-used long-term mechanical support option for the right ventricle, thus early identification, prevention and medical treatment of RVF is of the upmost importance. Areas covered: A PubMed search was first completed searching 'Right ventricular failure post-LVAD' which yielded 152 results, and a subsequent search was performed under 'RV mechanical support' which yielded 374 results, and was filtered to 'humans' and literature written in English, generating 219 results. We focused this research on pre-operative risk factors identified in the literature for developing RVF-post LVAD implantation, and the medical and surgical treatment options for RVF, including mechanical treatment options. Expert commentary: There is little consensus on pre-operative risk factors that reliably predict RVF post-LVAD implantation. Large prospective randomized trials would help clarify indications for specific medical and surgical therapy. We gather this knowledge in the present article and describe the main RVF remediation modalities. Surgeons and anesthesiologists should help prevent and have a low threshold for initiating supportive treatment for RVF, which may include increasingly invasive therapies up to long-term mechanical RV support.
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Affiliation(s)
| | - Marc Ruel
- a Division of Cardiac Surgery , University of Ottawa Heart Institute , Ottawa , Canada
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Jayaraman AL, Cormican D, Shah P, Ramakrishna H. Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: Techniques, limitations, and special considerations. Ann Card Anaesth 2017; 20:S11-S18. [PMID: 28074818 PMCID: PMC5299823 DOI: 10.4103/0971-9784.197791] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) refers to specific mechanical devices used to temporarily support the failing heart and/or lung. Technological advances as well as growing collective knowledge and experience have resulted in increased ECMO use and improved outcomes. Veno-arterial (VA) ECMO is used in selected patients with various etiologies of cardiogenic shock and entails either central or peripheral cannulation. Central cannulation is frequently used in postcardiotomy cardiogenic shock and is associated with improved venous drainage and reduced concern for upper body hypoxemia as compared to peripheral cannulation. These concerns inherent to peripheral VA ECMO may be addressed through so-called triple cannulation approaches. Veno-venous (VV) ECMO is increasingly employed in selected patients with respiratory failure refractory to more conventional measures. Newer dual lumen VV ECMO cannulas may facilitate extubation and mobilization. In summary, the pathology being addressed impacts the ECMO approach that is deployed, and each ECMO implementation has distinct virtues and drawbacks. Understanding these considerations is crucial to safe and effective ECMO use.
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Affiliation(s)
- Arun L Jayaraman
- Department of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic; Department of Critical Care Medicine, Mayo Clinic, Arizona, USA
| | - Daniel Cormican
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Allegheny General Hospital, Pennsylvania, USA
| | - Pranav Shah
- Department of Anesthesiology, Virginia Commonwealth University, Virginia, USA
| | - Harish Ramakrishna
- Department of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Arizona, USA
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Estrada VHN, Franco DLM, Moreno AAV, Gambasica JAR, Nunez CCC. Postoperative Right Ventricular Failure in Cardiac Surgery. Cardiol Res 2016; 7:185-195. [PMID: 28197291 PMCID: PMC5295509 DOI: 10.14740/cr500e] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2016] [Indexed: 12/11/2022] Open
Abstract
Two cases of patients that developed right ventricular failure (RVF) after cardiac valve surgery are presented with a narrative revision of the literature. RVF involves a great challenge due to the severity of this condition; it has a low incidence among non-congenital cardiac surgery patients, is more likely associated with cardiovascular and pulmonary complications related to cardiopulmonary bypass (CPB), and is a cause of acute graft failure and of a higher early mortality in cardiac transplant. The morphologic and hemodynamic characteristics of the right ventricle and some specific factors that breed pulmonary hypertension after cardiac surgery are in favor of the onset of RVF. Due to the possibility of complications after cardiac valve repair or replacement, measures as appropriate hemodynamic monitoring, to manage oxygenation, ventilation, sedation, acid base equilibrium and perfusion goals are a requirement, as well as a normal circulating volume, and the prevention of a disproportionate rise in the afterload, to preserve the free wall of the right ventricle (RV) and the septum's contribution to the right ventricular global function and geometry. If there is no response to these basic measures, the use of advanced therapy with inotropics, intravenous or inhaled pulmonary vasodilation agents is recommended; the use of mechanical ventricular assistance stands as a last resource.
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Abstract
OBJECTIVES The objectives of this review are to discuss the process of patient and mechanical device selection, operative management, and postoperative care with a focus on the management of right ventricular failure, anticoagulation strategies, device-related infections and neurologic sequelae. DATA SOURCES MEDLINE, PubMed. CONCLUSION The number of patients with advanced heart failure due to either acquired or congenital heart disease continues to increase, necessitating in some mechanical circulatory support and in others cardiac transplantation. With a limited cardiac donor pool, mechanical circulatory support is playing a greater role in the management of this population. The perioperative morbidity associated with mechanical circulatory support has lessened with improved postoperative management strategies.
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Minimally Invasive Right Ventricular Assist Device Implantation in a Patient with HeartWare left ventricular Assist Device. ASAIO J 2016; 61:e42-3. [PMID: 25914955 DOI: 10.1097/mat.0000000000000250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Many centers reported positive outcome after left ventricular assist devices (LVADs) implantation using a minimally invasive approach. The main drawback of this minimally invasive approach is the feasibility of right ventricular assist device (RVAD) implantation with direct cannulation of the pulmonary artery in cases of perioperative right ventricular failure (RVF). We report our experience with a 41-year-old male patient who was supported with a temporary RVAD using J-sternotomy approach for RVF after LVAD implantation. No technical issue was encountered, and the patient's condition stabilized immediately after RVAD implantation. However, several days later, the patient developed severe septic shock caused by pneumonia and died on the postoperative day 15 after RVAD implantation.
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Deschka H, Holthaus AJ, Sindermann JR, Welp H, Schlarb D, Monsefi N, Martens S, Scherer M. Can Perioperative Right Ventricular Support Prevent Postoperative Right Heart Failure in Patients With Biventricular Dysfunction Undergoing Left Ventricular Assist Device Implantation? J Cardiothorac Vasc Anesth 2016; 30:619-26. [DOI: 10.1053/j.jvca.2016.02.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Indexed: 01/16/2023]
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Anderson MB, Goldstein J, Milano C, Morris LD, Kormos RL, Bhama J, Kapur NK, Bansal A, Garcia J, Baker JN, Silvestry S, Holman WL, Douglas PS, O’Neill W. Benefits of a novel percutaneous ventricular assist device for right heart failure: The prospective RECOVER RIGHT study of the Impella RP device. J Heart Lung Transplant 2015; 34:1549-60. [DOI: 10.1016/j.healun.2015.08.018] [Citation(s) in RCA: 255] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/26/2015] [Accepted: 08/31/2015] [Indexed: 11/24/2022] Open
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Left ventricular vs. biventricular mechanical support: Decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation. Int J Cardiol 2015; 198:241-50. [DOI: 10.1016/j.ijcard.2015.06.103] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/08/2015] [Accepted: 06/26/2015] [Indexed: 11/16/2022]
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Welp H, Sindermann JR, Deschka H, Martens S, Scherer M. Pulmonary Bleeding During Right Ventricular Support After Left Ventricular Assist Device Implantation. J Cardiothorac Vasc Anesth 2015; 30:627-31. [PMID: 26460277 DOI: 10.1053/j.jvca.2015.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Right heart failure still occurs in up to 20% of patients after implantation of a left ventricular assist device (LVAD). One treatment option for these patients is the implantation of a temporary right ventricular assist device (RVAD). Experimental data suggest that non-pulsatile perfusion of the lungs is associated with an increased rate of pulmonary hemorrhage. The aim of this study was to determine the incidence of pulmonary bleeding complications in these patients. DESIGN Observational study. SETTING Single center, university hospital. PARTICIPANTS This study included patients undergoing LVAD implantation for end-stage heart failure and subsequent implantation of a temporary right ventricular support system. INTERVENTIONS In this study, 25 patients who underwent LVAD and additional temporary RVAD implantation were screened for pulmonary bleeding complications. MEASUREMENTS AND MAIN RESULTS The mean Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level at the time of LVAD implantation was 2.84. All patients experienced severe right ventricular failure (tricuspid annular plane systolic excursion [TAPSE], 10.16±26.3 mm) and severe pulmonary hypertension (right atrial [RA] pressure, 56.21±15.58 mmHg). Average duration of right ventricular support was 11.12±7.20 days, with right ventricular support being administered to 14 patients for more than 7 days. Seventeen patients were weaned successfully from right ventricular support after a mean support duration of 5 days. Five patients developed pulmonary bleeding complications, diagnosed using computed tomography scan and bronchoscopy. All bleeding occurred after postoperative day 7 and was associated with RVAD flow of more than 4 L/min within 24 hours before bleeding occurred. CONCLUSIONS The data presented in this study suggested that right ventricular support for more than 7 days and a blood flow greater than 4 L/min were associated with pulmonary bleeding complications. This should be taken into consideration when temporary right ventricular support after LVAD implantation is planned.
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Affiliation(s)
- Henryk Welp
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
| | - Jürgen R Sindermann
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany
| | - Heinz Deschka
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany
| | - Sven Martens
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany
| | - Mirela Scherer
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany
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Fischer Q, Kirsch M, Brochet E, Juliard JM. Bailout transcatheter closure of patent foramen ovale for refractory hypoxaemia after left ventricular assist device implantation. Interact Cardiovasc Thorac Surg 2015; 21:246-8. [PMID: 25912477 DOI: 10.1093/icvts/ivv105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/02/2015] [Indexed: 11/12/2022] Open
Abstract
We describe the interdisciplinary management of a 59-year old man with ischaemic cardiomyopathy on a HeartMate II left ventricular assist device (LVAD) and temporary right extracorporeal membrane oxygenation (ECMO) as a bridge-to-heart transplantation. He suffered refractory hypoxaemia due to massive right-to-left shunting by a patent foramen ovale (PFO), diagnosed after weaning off of temporary right ECMO. Percutaneous closure of the PFO was successfully achieved with an Amplatzer septal occluder device, which allowed the patient's extubation and departure from hospital. The patient received heart transplantation 7 weeks after LVAD implantation and was discharged from the intensive care unit 2 weeks after transplantation.
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Affiliation(s)
- Quentin Fischer
- Department of Cardiology, DHU FIRE, AP-HP, Hôpital Bichat, Université Paris-Diderot, Sorbonne Paris-Cité, INSERM U-1148, Paris, France
| | - Matthias Kirsch
- Department of Cardiac Surgery (M.K.), Groupe Hospitalier Bichat-Claude Bernard, AP-HP, Paris, France
| | - Eric Brochet
- Department of Cardiology, DHU FIRE, AP-HP, Hôpital Bichat, Université Paris-Diderot, Sorbonne Paris-Cité, INSERM U-1148, Paris, France
| | - Jean-Michel Juliard
- Department of Cardiology, DHU FIRE, AP-HP, Hôpital Bichat, Université Paris-Diderot, Sorbonne Paris-Cité, INSERM U-1148, Paris, France
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Saeed D, Maxhera B, Kamiya H, Lichtenberg A, Albert A. Alternative right ventricular assist device implantation technique for patients with perioperative right ventricular failure. J Thorac Cardiovasc Surg 2015; 149:927-32. [DOI: 10.1016/j.jtcvs.2014.10.104] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/11/2014] [Accepted: 10/26/2014] [Indexed: 10/24/2022]
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