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Beaulieu J, Vu C, Kalra S, Chahdi HO, Cousineau J, Matteau A, Mansour S, Jolicoeur EM, Jacques S, Nauche B, Podbielski R, Ferraro P, Poirier C, Potter BJ. Right Ventricular Assist Device with an Oxygenator for the Management of Combined Right Ventricular and Respiratory Failure: A Systematic Review. Can J Cardiol 2024:S0828-282X(24)00301-5. [PMID: 38604337 DOI: 10.1016/j.cjca.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Severe lung disease frequently presents with both refractory hypoxemia and right ventricular (RV) failure. OxyRVAD is an extra-corporeal membrane oxygenation (ECMO) configuration of RV bypass that also supplements gas exchange. This systematic review summarizes the available literature regarding the use of OxyRVAD in the setting of severe lung disease with associated RV failure. METHODS PubMed, Embase, and Google Scholar were queried on September 27th, 2023, for articles describing the use of an OxyRVAD configuration. The main outcome of interest was survival to ICU discharge. Data on the duration of OxyRVAD support and device-related complications were also recorded. RESULTS Of 475 identified articles, 33 were retained for analysis. Twenty-one articles were case reports and 12 were case series representing a total of 103 patients. No article provided a comparison group. Most patients (76.4%) were transitioned to OxyRVAD from another type of mechanical support. OxyRVAD was used as a bridge to transplant or curative surgery in 37.4% and as a bridge to recovery or decision in 62.6%. Thirty-one patients (30.1%) were managed with the dedicated single-access dual-lumen ProtekDuo cannula. Median time on OxyRVAD was twelve days (IQR 8-23) and survival to ICU discharge was 63.9%. Device-related complications were infrequently reported. CONCLUSION OxyRVAD support is a promising alternative for RV support when gas exchange is compromised with good ICU survival in selected cases. Comparative analyses in patients with RV failure with and without severe lung disease are needed.
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Affiliation(s)
| | - Christine Vu
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC
| | - Sanjog Kalra
- Interventional Cardiology, Department of Medicine, University Health Network (UHN), Toronto, ON
| | | | - Julie Cousineau
- Intensive Care Medicine, Department of Medicine, CHUM, Montréal, QC
| | - Alexis Matteau
- CHUM Research Center (CRHCUM), Montreal, QC; Interventional Cardiology, Department of Medicine, CHUM, Montréal, QC; Cardiac Intensive Care Unit, Department of Medicine, CHUM, Montréal, QC
| | - Samer Mansour
- CHUM Research Center (CRHCUM), Montreal, QC; Interventional Cardiology, Department of Medicine, CHUM, Montréal, QC; Cardiac Intensive Care Unit, Department of Medicine, CHUM, Montréal, QC
| | - E Marc Jolicoeur
- CHUM Research Center (CRHCUM), Montreal, QC; Interventional Cardiology, Department of Medicine, CHUM, Montréal, QC; Cardiac Intensive Care Unit, Department of Medicine, CHUM, Montréal, QC
| | | | - Bénédicte Nauche
- Bibliothèque du CHUM, Direction de l'enseignement et de l'Académie CHUM (DEAC), CHUM, Montréal, QC
| | - Renata Podbielski
- Bibliothèque du CHUM, Direction de l'enseignement et de l'Académie CHUM (DEAC), CHUM, Montréal, QC
| | - Pasquale Ferraro
- CHUM Research Center (CRHCUM), Montreal, QC; Thoracic Surgery, Department of Surgery, CHUM, Montréal, QC; Lung Transplant Program, CHUM, Montréal, QC
| | - Charles Poirier
- CHUM Research Center (CRHCUM), Montreal, QC; Lung Transplant Program, CHUM, Montréal, QC; Respirology, Department of Medicine, CHUM, Montréal, QC
| | - Brian J Potter
- CHUM Research Center (CRHCUM), Montreal, QC; Interventional Cardiology, Department of Medicine, CHUM, Montréal, QC; Cardiac Intensive Care Unit, Department of Medicine, CHUM, Montréal, QC.
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Maybauer MO, Reaves ZR, Brewer JM. Feasibility of using the ProtekDuo cannula in V-P ECMO and PROpella configurations during ground and air transport. Perfusion 2024; 39:620-623. [PMID: 36562322 DOI: 10.1177/02676591221148606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Use of the ProtekDuo cannula has been described for right ventricular assist devices (RVADs) and extracorporeal membrane oxygenation (ECMO) systems. CASE REPORT We describe remote cannulation and transport of two patients with ProtekDuo cannula. One patient had isolated acute right ventricular failure (aRVF), was cannulated with ProtekDuo cannula in venopulmonary (V-P) configuration and transported by ambulance. Another patient had biventricular failure after myocardial infarction, was supported with ProtekDuo and Impella CP in PROpella configuration, and transported by helicopter. DISCUSSION We appear to be the first group to report remote cannulation using the ProtekDuo cannula followed by ambulance and helicopter transport, which were performed without complication. We describe the pros and cons of these configurations in comparison to the gold standard of shock management with venoarterial ECMO, as well as important considerations for transport. CONCLUSION Use of the ProtekDuo cannula for remote cannulations and transport is feasible and appears safe.
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Affiliation(s)
- Marc O Maybauer
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida, Gainesville, FL, USA
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, Australia
| | - Zachary R Reaves
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Specialty Critical Care, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - Joseph M Brewer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Specialty Critical Care, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
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John KJ, Nabzdyk CGS, Chweich H, Mishra AK, Lal A. ProtekDuo percutaneous ventricular support system-physiology and clinical applications. Ann Transl Med 2024; 12:14. [PMID: 38304906 PMCID: PMC10777236 DOI: 10.21037/atm-23-1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/09/2023] [Indexed: 02/03/2024]
Abstract
The ProtekDuo (LivaNova, London, UK) cannula is a dual-lumen device, typically inserted into the right internal jugular (IJ) vein through a percutaneous approach, with fluoroscopy or ultrasound guidance. When connected to a pump, such as the TandemHeart (LivaNova, London, UK) or CentriMag (Abbott, Pleasanton, CA, USA), it can function as a right ventricular (RV) mechanical circulatory support (MCS). When an oxygenator is also added [veno-pulmonary (V-P)], it can provide extracorporeal membrane oxygenation (ECMO) support. This review aims to provide a comprehensive overview of the device's physiology and clinical applications. In the setting of RV failure (RVF), the ProtekDuo cannula, with its outflow in the main pulmonary artery (PA), can bypass the failing RV, improving pulmonary flow, left atrial (LA) filling pressures, and left ventricular (LV) preload. This can also reduce ventricular interdependence and leftward shift of the interventricular septum that occurs in RVF. In this review, the key sections expand on the use of the ProtekDuo cannula in the management of critically ill patients, specifically, the use of ProtekDuo for RV myocardial infarction (MI) RVF, LV assist device (LVAD) implantation-associated RVF, RVF post-heart transplantation, temporary biventricular MCS as bridge to recovery (ECpella 2.0 or PROpella), biventricular support as bridge to recovery or decision, isolated LV failure, post lung transplantation (LT) care, and other miscellaneous clinical scenarios. ProtekDuo is an important tool in the armory of RVF management. The ProtekDuo system is expected to gain more popularity given its clear advantages such as groin-free approach allowing for mobility, easy percutaneous deployment, compatibility with various pumps and oxygenators, and the versatility to be integrated in numerous configurations. In an era of expanding MCS options, further research is needed to better understand the optimal tool for specific patient subsets.
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Affiliation(s)
- Kevin John John
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Christoph G. S. Nabzdyk
- Biomedical Innovation and Translation, Critical Care & Cardiac Anesthesia, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Haval Chweich
- Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, Boston, MA, USA
| | - Ajay Kumar Mishra
- Department of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Amos Lal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Haq SH, Shah SR, Golzarian H, Laird A, Cole W, Patel SM. A Novel Percutaneous Snare-Assisted Manipulation and Repositioning of a ProtekDuo Cannula in a COVID-19 Acute Respiratory Distress Syndrome. Am J Cardiol 2024; 210:113-115. [PMID: 37944412 DOI: 10.1016/j.amjcard.2023.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 11/12/2023]
Abstract
Venovenous extracorporeal membrane oxygenation [VV-ECMO] has gained increasing notoriety during the COVID-19 pandemic as a salvation therapy for fulminant respiratory failure. Various configurations can present unique challenges in management. For instance, the ProtekDuo cannula is a 29Fr to 31Fr dual-lumen cannula inserted by way of the right internal jugular vein that allows for right atrium to pulmonary artery bypass with an attached oxygenator, essentially resulting in VV-ECMO. Understanding that these different configurations inevitably dictate the types of complications that can arise during the circuit implantation and management is imperative. However, in a hemodynamically unstable patient, time or resources may not permit standard maneuvers for management. In conclusion, we present an innovative, percutaneous approach which allowed the restoration of flow and oxygenation in a decompensating ProtekDuo patient without having to explant/disconnect the circuit or implant a new VV-ECMO circuit.
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Affiliation(s)
- Syed H Haq
- Department of Internal Medicine, BonSecour Mercy Health-St. Rita's Medical Center, Lima, Ohio
| | - Sidra R Shah
- Department of Internal Medicine, BonSecour Mercy Health-St. Rita's Medical Center, Lima, Ohio
| | - Hafez Golzarian
- Department of Internal Medicine, BonSecour Mercy Health-St. Rita's Medical Center, Lima, Ohio
| | - Amanda Laird
- Department of Critical Care Medicine, BonSecour Mercy Health-St. Rita's Medical Center, Lima, Ohio
| | - William Cole
- Department of Critical Care Medicine, BonSecour Mercy Health-St. Rita's Medical Center, Lima, Ohio
| | - Sandeep M Patel
- Structural Heart & Intervention Center, BonSecour Mercy Health-St. Rita's Medical Center, Lima, Ohio.
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Tarzia V, Ponzoni M, Pittarello D, Gerosa G. Test Bench for Right Ventricular Failure Reversibility: The Hybrid BiVAD Concept. J Clin Med 2023; 12:7604. [PMID: 38137672 PMCID: PMC10744029 DOI: 10.3390/jcm12247604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND When heart transplantation and myocardial recovery are unlikely, patients presenting with biventricular cardiogenic shock initially treated with extracorporeal membrane oxygenation (ECMO) may benefit from a mechanical support upgrade. In this scenario, a micro-invasive approach is proposed: the combination of the double-lumen ProtekDuo cannula (Livanova, London, UK) and the Impella 5.5 (Abiomed, Danvers, MA) trans-aortic pump that translates into a hybrid BiVAD. METHODS All consecutive ECMO patients presenting with biventricular cardiogenic shock and ineligibility to heart transplantation from August 2022 were prospectively enrolled. The clinical course, procedural details, and in-hospital events were collected via electronic medical records. RESULTS A total of three patients, who were temporarily not eligible for heart transplantation or durable LVAD due to severe acute pneumonia and right ventricular (RV) dysfunction, were implanted with a hybrid BiVAD. This strategy provided high-flow biventricular support while pulmonary function ameliorated. Moreover, by differentially sustaining the systemic and pulmonary circulation, it allowed for a more adequate reassessment of RV function. All the patients were considered eligible for isolated durable LVAD and underwent less invasive LVAD implantation paired with a planned postoperative RVAD. In all cases, RV function gradually recovered and the RVAD was successfully removed. CONCLUSIONS The Hybrid BiVAD represents an up-to-date micro-invasive mechanical treatment of acute biventricular failure beyond ECMO. Its rationale relies on more physiological circulation across the lungs, the complete biventricular unloading, and the possibility of including an oxygenator in the circuit. Finally, the independent and differential control of pulmonary and systemic flows allows for more accurate RV function evaluation for isolated durable LVAD eligibility reassessment.
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Affiliation(s)
- Vincenzo Tarzia
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy; (M.P.); (G.G.)
| | - Matteo Ponzoni
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy; (M.P.); (G.G.)
| | - Demetrio Pittarello
- Institute of Anesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy;
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy; (M.P.); (G.G.)
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Brewer JM, Broman LM, Swol J, Lorusso R, Conrad SA, Maybauer MO. Standardized nomenclature for peripheral percutaneous cannulation of the pulmonary artery in extracorporeal membrane oxygenation: Current uptake and recommendations for improvement. Perfusion 2023:2676591231210457. [PMID: 37930875 DOI: 10.1177/02676591231210457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The rising application of extracorporeal membrane oxygenation (ECMO) has emphasized the need for consistent and standardized terminology, especially concerning peripheral percutaneous cannulation of the pulmonary artery (PPC-PA). The Extracorporeal Life Support Organization (ELSO) Nomenclature Task Force produced the ELSO Maastricht Treaty for extracorporeal life support (ECLS) Nomenclature to address this challenge. However, adherence to nomenclature recommendations has been poor in publications describing PPC-PA. We aim to describe common nomenclature errors and provide a user-guide for abbreviations that can be used by authors, reviewers, and journal staff to ensure properadherence to standardized nomenclature in publications describing PPC-PA.
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Affiliation(s)
- J Michael Brewer
- Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - L Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Roberto Lorusso
- ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Center, Maastricht University Medical Center, Maastricht (MUMC), The Netherlands
- Cardiovascular Research Institute (CARIM), Maastricht, the Netherlands
| | - Steven A Conrad
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - 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, FL, USA
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Maybauer MO, Brewer JM. The protekduo cannula for acute right ventricular support in thyrotoxicosis. Ann Card Anaesth 2023; 26:464-467. [PMID: 37861588 PMCID: PMC10691564 DOI: 10.4103/aca.aca_26_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 10/21/2023] Open
Abstract
A 25-year-old female was presented with acute right heart failure (aRHF) and cardiogenic shock secondary to thyrotoxicosis with concomitant acute respiratory failure. A ProtekDuo cannula was placed to provide temporary percutaneous right ventricular assistance and extracorporeal membrane oxygenation (ECMO) in venopulmonary (V-P) configuration, which provided both decompression of the right ventricle (RV) and oxygenation. With treatment of the underlying thyrotoxicosis, the RV function improved and respiratory failure resolved. She was discharged home in good condition. This case details alternative ECMO management with ProtekDuo compared to the gold standard of venoarterial (V-A) ECMO.
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Affiliation(s)
- Marc O. Maybauer
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida, College of Medicine, Gainesville, FL, USA
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Brisbane, Australia
| | - Joseph M. Brewer
- INTEGRIS Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, Oklahoma City, OK, USA
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8
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El Banayosy AM, El Banayosy A, Smith JG, Brewer JM, Mihu MR, Swant LV, Schoaps RS, Sharif A, Benson C, Maybauer MO. Extracorporeal life support in pregnant and postpartum women with COVID-19-related acute respiratory distress syndrome. Int J Artif Organs 2023; 46:289-294. [PMID: 37051661 PMCID: PMC10099914 DOI: 10.1177/03913988231168431] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Extracorporeal membrane oxygenation (ECMO) is an intervention used for patients with acute respiratory distress syndrome (ARDS) from COVID-19 who have failed conventional ventilatory strategies. Very few studies have given insight into the outcomes of pregnant and postpartum patients requiring ECMO support. METHODS Single center, retrospective, observational study of female pregnant and postpartum patients suffering COVID-19 ARDS and requiring ECMO. RESULTS Eight SARS-CoV-2 positive patients were identified. The average age was 31 ± 4 years, with Body Mass Indices (BMI) and SOFA scores ranging between 32-49 and 8-11, respectively. Two patients were pregnant at the time of ECMO initiation, two were peripartum, and four were postpartum. Five patients (63%) had bleeding, and one patient had a hysterectomy. Seven patients (88%) were supported by V-V ECMO and one with V-A ECMO. Patients had between one and three circuit exchanges due to oxygenator failure or clots in the circuit. All patients were in ICU between 7 and 74 days, with hospital length of stay between 8 and 81 days. All patients were weaned off ECMO and were successfully discharged from the hospital. All newborns were born via cesarean section, and all survived to discharge. CONCLUSION Our study shows a 100% neonatal and maternal survival rate demonstrating that ECMO in this patient population is safe. These patients should be transferred to experienced high-volume ECMO centers with the ability to perform emergent cesarean sections. ECMO should be considered a life-saving therapy for pregnant women with severe COVID-19 with an overall excellent maternal and neonatal survival rate.
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Affiliation(s)
- Ahmed M El Banayosy
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Aly El Banayosy
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Jennifer G Smith
- The Perinatal Center, Maternal Fetal Medicine, Oklahoma City, OK, USA
| | - Joseph M Brewer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Mircea R Mihu
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
- Department of Medicine/Cardiology, Oklahoma State University, Tulsa, OK, USA
| | - Laura V Swant
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Robert S Schoaps
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Ammar Sharif
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Clayne Benson
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Marc O Maybauer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
- Department of Medicine/Cardiology, Oklahoma State University, Tulsa, OK, USA
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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Alam A, Baran DA, Doshi H, Van Zyl J, Patlolla S, Salem M, Afzal A, Al-Saffar F, Hall SA. Safety and efficacy of ProtekDuo right ventricular assist device: A systemic review. Artif Organs 2023. [PMID: 37012224 DOI: 10.1111/aor.14525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 01/04/2023] [Accepted: 03/12/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Right ventricular failure is associated with increased morbidity and mortality. The ProtekDuo (Livanova, Uk) is a dual-lumen cannula that allows for percutaneous right ventricular support and may be connected to a centrifugal blood pump such as the TandemHeart or LifeSparc (Livanova, UK). This systematic review aims to evaluate the safety and efficacy of ProtekDuo right ventricular support and evaluate potential clinical variables that can influence outcomes. METHODS PubMed, MEDLINE, SCOPUS, EMBASE, and the Cochrane Library were systematically searched. Studies meeting inclusion criteria, where ProtekDuo was used as the right ventricular assist device with reported numerical death counts for mortality as outcome measures. The primary endpoints were in-hospital 30-day and 1-year mortality rates. Secondary endpoints included ICU length of stay, conversion rates to surgical RVADs, ProtekDuo wean rates, duration of use of ProtekDuo, and adverse event rates. RESULTS Of 49 studies reviewed, 7 met inclusion criteria with study periods between October 2014 and November 2019. ProtekDuo was utilized due to RV failure post-LVAD insertion in 64.8% (68/105) of patients. In-hospital mortality, 30-day mortality, and 1-year mortality ranged between 9%-46%, 15%-40%, and 19%-40%, respectively. Weaning from ProtekDuo and conversion to surgical RVAD ranged between 24%-91% and 11%-35%, respectively. The ICU stay average ranged from 15.8 to 36 days and ProtekDuo mean support duration ranged from 10.5 to 58 days. CONCLUSION The ProtekDuo cannula is increasingly utilized as a right ventricular support device. Despite the sparse retrospective data available with variable patient characteristics and study design, percutaneous RV mechanical support via ProtekDuo cannula is a safe and feasible option.
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Affiliation(s)
- Amit Alam
- Center for Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Texas, Dallas, USA
- Texas A&M University College of Medicine, Dallas, Texas, USA
| | - David A Baran
- Cleveland Clinic Heart, Vascular and Thoracic Institute, Weston, Florida, USA
| | - Harsh Doshi
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Johanna Van Zyl
- Center for Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Texas, Dallas, USA
| | - Srikant Patlolla
- Center for Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Texas, Dallas, USA
| | - Mahmoud Salem
- University of Pittsburg Medical Center, Harrisburg, Pennsylvania, USA
| | - Aasim Afzal
- Center for Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Texas, Dallas, USA
- Texas A&M University College of Medicine, Dallas, Texas, USA
| | - Farah Al-Saffar
- Center for Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Texas, Dallas, USA
- Texas A&M University College of Medicine, Dallas, Texas, USA
| | - Shelley A Hall
- Center for Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Texas, Dallas, USA
- Texas A&M University College of Medicine, Dallas, Texas, USA
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James L, Smith DE. Supporting the "forgotten" ventricle: The evolution of percutaneous RVADs. Front Cardiovasc Med 2023; 9:1008499. [PMID: 36684567 PMCID: PMC9845717 DOI: 10.3389/fcvm.2022.1008499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023] Open
Abstract
Right heart failure (RHF) can occur as the result of an acute or chronic disease process and is a challenging clinical condition for surgeons and interventionalists to treat. RHF occurs in approximately 0.1% of patients after cardiac surgery, in 2-3% of patients following heart transplantation, and in up to 42% of patients after LVAD implantation. Regardless of the cause, RHF portends high morbidity and mortality and is associated with longer hospital stays and higher healthcare costs. The mainstays of traditional therapy for severe RHF have included pharmacological support, such as inotropes and vasopressors, and surgical right ventricular (RV) assist devices. However, in recent years catheter-based mechanical circulatory support (MCS) strategies have offered novel solutions for addressing RHF without the morbidity of open surgery. This manuscript will review the pathophysiology of RHF, including the molecular underpinnings, gross structural mechanisms, and hemodynamic consequences. The evolution of techniques for supporting the right ventricle will be explored, with a focus on various institutional experiences with percutaneous ventricular assist devices.
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11
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Brewer JM, Capoccia M, Maybauer DM, Lorusso R, Swol J, Maybauer MO. The ProtekDuo dual-lumen cannula for temporary acute mechanical circulatory support in right heart failure: A systematic review. Perfusion 2023; 38:59-67. [PMID: 36597024 DOI: 10.1177/02676591221149859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Acute right ventricular failure (aRVF) is associated with high mortality and morbidity. Mechanical circulatory support (MCS) may be considered as an advanced treatment option. The ProtekDuo is a cannula that can be used to provide acute right ventricular support as part of a temporary percutaneous (tp) right ventricular assist device (RVAD) system. The primary objective of this systematic review is to describe patient survival and complications when the ProtekDuo cannula was used as part of an tpRVAD system. METHODS MEDLINE, Embase, and Scopus were searched from database inception to August 26, 2022. Reference sections of studies were reviewed to screen for database omissions. RESULTS Seven studies with 127 patients were eligible for inclusion. The studies included patients with aRVF from a variety of causes. Mean duration of support was between 10 and 58 days in five studies. Patient survival to discharge was between 60% and 85.2% in two studies. Four authors reported 30-day survival between 60% and 85.2%. Devicerelated and non-device related complications were low. CONCLUSIONS Patients treated with RVAD using the ProtekDuo cannula have comparable survival rates and complications to other tpRVAD systems. Several advantages exist compared to other RVAD systems.
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Affiliation(s)
- Joseph M Brewer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac Care, Specialty Critical Care and Acute Circulatory Support Service, 23171Integris Baptist Medical Center, Oklahoma, OK, USA
| | - Massimo Capoccia
- Department of Cardiac Surgery, 4472Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dirk M Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, 9377Philipps University, Marburg, Germany
| | - Roberto Lorusso
- Department of Cardio Thoracic Surgery, 82246Maastricht University Medical Center, Maastricht, Netherlands
| | - Justyna Swol
- Department of Respiratory Medicine, 470426Paracelsus Medical University, Nuremberg, Germany
| | - Marc O Maybauer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac Care, Specialty Critical Care and Acute Circulatory Support Service, 23171Integris Baptist Medical Center, Oklahoma, OK, USA.,Department of Anaesthesiology and Intensive Care Medicine, 9377Philipps 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, FL, USA
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12
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Maybauer MO, Capoccia M, Maybauer DM, Lorusso R, Swol J, Brewer JM. The ProtekDuo in ECMO configuration for ARDS secondary to COVID-19: A systematic review. Int J Artif Organs 2022; 46:93-98. [PMID: 36495090 PMCID: PMC9747364 DOI: 10.1177/03913988221142904] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Assessment of the results of the ProtekDuo cannula applied for dedicated right ventricular support with oxygenator in ARDS secondary to COVID-19. METHODS Systematic literature search in NHS library, Medline (Pubmed) and EMBASE using appropriate keywords as well as PICOS and PRISMA approach. RESULTS Out of 285 publications found, 5 publications met the search criteria and were included in this review. A total of 194 patients with ARDS secondary to COVID-19 underwent ProtekDuo placement to establish a combination of respiratory [veno-venous extracorporeal membrane oxygenation (V-V ECMO)] and right ventricular support. Patients treated using the ProtekDuo cannula had survival rates between 59% and 89% throughout the five studies, and a significant survival benefit when compared to an invasive ventilation group or compared to dual site V-V ECMO or other double lumen ECMO cannulas. One study focused on extubation and discontinuation of ventilator support, which could be achieved in 100% of ProtekDuo patients. An association for reduced incidence of acute kidney injury (AKI) and use of continuous renal replacement therapy (CRRT) could be shown when the ProtekDuo was used. CONCLUSION Only limited literature is available for the ProtekDuo in V-P ECMO configuration in the setting of COVID-19 ARDS and should be interpreted with caution. Data on the ProtekDuo is suggestive for lower rates of mortality, AKI and CRRT as compared to other respiratory support modalities.
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Affiliation(s)
- Marc O Maybauer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Specialty Critical Care, Oklahoma City, OK, USA,Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany,Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia,Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL, USA,Marc O Maybauer, Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA.
| | - Massimo Capoccia
- Department of Cardiac Surgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dirk M Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany,Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Roberto Lorusso
- ECLS Centrum, Cardio -Thoracic Surgery Department, Heart & Vascular Center, Maastricht University Medical Center, Maastricht (MUMC), The Netherlands; and Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - Justyna Swol
- Department of Pneumology, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Joseph M Brewer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Specialty Critical Care, Oklahoma City, OK, USA
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13
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Tarzia V, Ponzoni M, Pittarello D, Gerosa G. Planned Combo Strategy for LVAD Implantation in ECMO Patients: A Proof of Concept to Face Right Ventricular Failure. J Clin Med 2022; 11:jcm11237062. [PMID: 36498641 PMCID: PMC9740870 DOI: 10.3390/jcm11237062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/20/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
We propose a patient-tailored strategy that considers the risk for postoperative right heart failure, utilizing the percutaneous ProtekDuo cannula (Livanova, London, UK) in an innovative way to perform cardiopulmonary bypass during LVAD implantation in ECMO patients. Our novel protocol is based on the early intra-operative use of the ProtekDuo cannula, adopting the distal lumen as the pulmonary vent and the proximal lumen as the venous inflow cannula during cardiopulmonary bypass. This configuration is rapidly switched to the standard fashion to provide planned postoperative temporary right ventricular support, in selected patients at high risk of right ventricular failure. From September 2020 to June 2022, six patients were supported with the ProtekDuo cannula during and after an intracorporeal LVAD implantation (five of which were minimally invasive): four HeartMate III (Abbott, U.S.A.) and two HVAD (Medtronic Inc, MN). In all cases, the ProtekDuo cannula was correctly positioned and removed without complications after a median period of 8 days. Non-fatal bleeding (bronchial hemorrhage) occurred in one patient (17%) during biventricular support. Thirty-day mortality was 0%. From this preliminary work, our novel strategy demonstrated to be a feasible solution for planned minimally invasive right ventricular support in ECMO patients scheduled for a durable LVAD implantation.
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Affiliation(s)
- Vincenzo Tarzia
- Cardiac Surgery and Heart Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-0498212412; Fax: +39-0498212409
| | - Matteo Ponzoni
- Cardiac Surgery and Heart Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35128 Padova, Italy
| | - Demetrio Pittarello
- Anaesthesia and Intensive Care Unit, University of Padova, 35128 Padova, Italy
| | - Gino Gerosa
- Cardiac Surgery and Heart Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35128 Padova, Italy
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14
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Maybauer MO, Koerner MM, Swol J, Banayosy AE, Maybauer DM. The novel ProtekDuo ventricular assist device: Configurations, technical aspects, and present evidence. Perfusion 2022:2676591221090607. [PMID: 35619541 DOI: 10.1177/02676591221090607] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The ProtekDuo, single site dual lumen cannula can be used in a multitude of configurations. In the medical literature, the ProtekDuo is described as right ventricular assist device (RVAD), as left ventricular assist device (LVAD), as biventricular assist device (BiVAD) when combined with an Impella device or other LVAD's, as double lumen drainage cannula on cardiopulmonary bypass (CPB), as RVAD with oxygenator, in veno-pulmonary (V-P) ECMO configuration, venovenous-pulmonary (VV-P) ECMO configuration with additional drainage cannula, and in veno-venopulmonary (V-VP) ECMO configuration as double lumen return cannula. Improvements in flow and oxygenation have been recognized in various settings and need further scientific evaluation. We summarized the above-mentioned configurations, technical aspects, and the present literature available for the ProtekDuo.
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Affiliation(s)
- 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,BNE, Australia.,Advanced Cardiac and Critical Care, Intergris Baptist Medical Center, Nazih Zuhdi Transplant Institute, Oklahoma City, OK, USA.,Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, OK, USA
| | - Michael M Koerner
- Advanced Cardiac and Critical Care, Intergris Baptist Medical Center, Nazih Zuhdi Transplant Institute, Oklahoma City, OK, USA.,Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, OK, USA.,Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
| | - Justyna Swol
- Department of Pneumology, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Aly El Banayosy
- Advanced Cardiac and Critical Care, Intergris Baptist Medical Center, Nazih Zuhdi Transplant Institute, Oklahoma City, OK, USA
| | - Dirk M Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany.,Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane,BNE, Australia
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15
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Oliveros E, Collado FM, Poulin MF, Seder CW, March R, Kavinsky CJ. Percutaneous Right Ventricular Assist Device Using the TandemHeart ProtekDuo: Real-World Experience. J Invasive Cardiol 2021; 33:E407-E411. [PMID: 33771937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Acute right ventricular (RV) failure is challenging to treat and mechanical circulatory support devices are limited. The TandemHeart ProtekDuo (THPD; TandemLife) is a novel percutaneous RV assist device that can provide 4.0 liters per minute of blood flow through venovenous extracorporeal life support. It allows venous drainage from the right atrium and reinfusion of blood into the main pulmonary artery via internal jugular vein access. We aim to provide real-world insight into disease characteristics resulting in the use of THPD for mechanical support and enhance knowledge of best practice regarding clinical management weaning and removal/exit strategies. METHODS We retrospectively collected data of consecutive patients who received a THPD device at our center for acute RV failure between August 2015 and February 2018. RESULTS Eleven patients were diagnosed with acute RV failure and required placement of THPD. The hospital length of stay ranged from 12 to 223 days. The average length of support ranged from 11 to 154 days. We observed complications such as stroke (18.2%), sepsis (63.6%), massive gastrointestinal bleed (45.5%), and heparin-induced thrombocytopenia (54.5%). These patients received on average 85 units of blood products. Survival was 82% at 30 days and 72% at 180 days. Six of the patients were successfully weaned from the THPD devices and 1 patient required venovenous extracorporeal life support. CONCLUSIONS This real-world experience, despite high morbidity, continues to suggest benefits of THPD for patients with severe acute RV failure.
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Affiliation(s)
| | | | | | | | | | - Clifford J Kavinsky
- Rush University Medical Center, 1717 West Congress Parkway, Suite 307 Kellogg, Chicago, IL 60612 USA.
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16
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Arora S, Atreya AR, Birati EY, Shore S. Temporary Mechanical Circulatory Support as a Bridge to Heart Transplant or Durable Left Ventricular Assist Device. Interv Cardiol Clin 2021; 10:235-249. [PMID: 33745672 DOI: 10.1016/j.iccl.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Advanced heart failure refractory to medical therapy can result in patients presenting with progressively worsening hypoperfusion and cardiogenic shock. Temporary mechanical circulatory support is often necessary as a bridge to heart transplant or durable ventricular assist devices. These devices increase cardiac output. Several options are available for left ventricular support. With the exception of venoarterial extracorporeal membrane oxygenation, all other devices decrease left ventricular end-diastolic pressure. The choice of device should be driven by patient needs and the treating teams comfort. Timely identification of cardiogenic shock and use of shock teams are potential strategies that can help improve survival.
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Affiliation(s)
- Sonali Arora
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences Hospitals, 1-8-31/1, Minister Road, Krishna Nagar Colony, Secunderabad, Telangana 500003, India
| | - Auras R Atreya
- Interventional Cardiology, AIG Institute of Cardiac Sciences and Research, 1, Mindspace Road, Gachibowli, Hyderabad, Telangana 500032, India
| | - Edo Y Birati
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Division of Cardiovascular Medicine, Poriya Medical Center, Israel 152801; Perelman Center for Advanced Medicine, 11th Floor, South Tower, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Supriya Shore
- Department of Internal Medicine, Division of Cardiovascular Disease, University of Michigan, Ann Arbor, MI 48103, USA; University of Michigan, North Campus Research Complex, 2800 Plymouth Road, 16-169C, Ann Arbor, MI 48109, USA.
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17
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Sinha N, Goodarzi A, Akku R, Balayla G. ProtekDuo as a bridge to lung transplant and heart-lung transplant. Clin Transplant 2021; 35:e14273. [PMID: 33655518 DOI: 10.1111/ctr.14273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
Recent advances in technology have led to significantly greater use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation with better outcomes. The novel ProtekDuo veno-venous ECMO (CardiacAssist, Inc.) has gained significance as it facilitates effective decompression of the right heart in patients with acute decompensation, while also providing consistent and effective gas exchange by eliminating recirculation. Here, we report two cases of effectively using ProtekDuo veno-venous ECMO: one case as a bridge to lung transplantation and another case as a bridge to heart-lung transplantation.
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Affiliation(s)
- Neeraj Sinha
- Division of Pulmonary and Critical Care Medicine, Transplant Pulmonology, Miami Transplant Institute, University of Miami, Miami, FL, USA
| | - Ahmad Goodarzi
- Division of Pulmonary and Critical Care Medicine, Pulmonology, Transplant Pulmonology, Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - Radhika Akku
- California Institute of Behavioral Neurosciences and Psychology, Fairfield, CA, USA
| | - Galit Balayla
- General Medicine, Central University of Venezuela, Caracas, Venezuela
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18
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Chivasso P, Miele M, Romano R, Frunzo F, Presutto O, Colombino M, Cafarelli F, Baldi C, Fiore E, Masiello P, Mastrogiovanni G, Iesu S. Impella CP and ProtekDuo as a bridge to recovery following surgical revascularization complicated by electrical storm. Gen Thorac Cardiovasc Surg 2021; 69:877-881. [PMID: 33400196 DOI: 10.1007/s11748-020-01571-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
Short-term mechanical circulatory support (MCS) devices are designed to provide hemodynamic support for a wide range of clinical conditions such as high-risk cardiac surgery or interventional procedures, post-cardiotomy cardiogenic shock, acute decompensated heart failure. Electrical storm (defined as three or more sustained episodes of ventricular fibrillation-VF- in a 24-h period) is a rare but critical complication following revascularization in patients with ischemic heart disease and it is associated with a very high mortality (80-90%) both during the incident alone and during further observation. Here we report the case of a 38-year-old patient affected by coronary artery disease with moderate to severe left ventricular systolic dysfunction (EF 30-35%) who underwent emergency coronary artery bypass grafting (CABG) complicated by electrical storm and severe haemodynamic instability, successfully managed with a novel approach of biventricular mechanical circulatory support with extracorporeal life support (ECLS) in first instance, subsequently switched to Impella CP and ProtekDuo.
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Affiliation(s)
- Pierpaolo Chivasso
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy.
| | - Mario Miele
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Rosalba Romano
- Department of Cardiac Anaethesia, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Francesco Frunzo
- Department of Cardiac Anaethesia, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Oreste Presutto
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Mario Colombino
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Francesco Cafarelli
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Cesare Baldi
- Department of Interventional Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Emanuele Fiore
- Department of Cardiac Anaethesia, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Paolo Masiello
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Generoso Mastrogiovanni
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Severino Iesu
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
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Belani K, Saikus CE, Schroder JN, Klinger RY. Transapical ProtekDuo Rapid Deployment Cannula as Temporary Left Ventricular Assist Device in a Jehovah's Witness Patient. J Cardiothorac Vasc Anesth 2020; 35:3735-3742. [PMID: 33388220 DOI: 10.1053/j.jvca.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 11/11/2022]
Abstract
Temporary left ventricular support aims to decompress the left ventricle and provide adequate forward flow into the arterial circulation. This can be accomplished with endovascular devices such as the Impella with an internal motor, or with the implementation of cannulae to drain the left ventricle or left atrium and then return to the arterial circulation using an external pump. In this report, the authors describe the transesophageal echocardiography-guided placement of a single-cannula system with the Protek Duo RD (TandemLife, LivaNova) via a left ventricular apical approach to provide minimally invasive left ventricular support in a high-risk Jehovah's Witness patient.
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Affiliation(s)
- Kiran Belani
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, MA.
| | - Christina E Saikus
- Cleveland Clinic, Heart and Vascular Institute, Thoracic and Cardiovascular Surgery, Cleveland, OH
| | - Jacob N Schroder
- Duke University Medical Center, Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Durham, NC
| | - Rebecca Y Klinger
- Duke University Medical Center, Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Durham, NC
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Ruhparwar A, Zubarevich A, Osswald A, Raake PW, Kreusser MM, Grossekettler L, Karck M, Schmack B. ECPELLA 2.0-Minimally invasive biventricular groin-free full mechanical circulatory support with Impella 5.0/5.5 pump and ProtekDuo cannula as a bridge-to-bridge concept: A first-in-man method description. J Card Surg 2019; 35:195-199. [PMID: 31609509 DOI: 10.1111/jocs.14283] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiogenic shock (CS) from biventricular heart failure that requires acute mechanical circulatory support (MCS) is associated with high mortality. Different MCS methods and techniques have emerged as a standard of care in CS. Nevertheless, the routine MCS approach carries multiple limitations such as limb ischemia, missing of left ventricular unloading and immobilization. We describe a method to establish a groin-free full support MCS in patients with CS without the need for thoracotomy. This is the first report of the ECPELLA 2.0 concept, a peripheral groin-free biventricular MCS in patients with acute CS. METHODS AND RESULTS We discuss two patients in acute CS (INTERMACS I) treated with two peripheral MCS devices (Impella 5.0 or 5.5 surgically via an axillary artery and ProtekDuo cannula percutaneously via a right internal jugular vein) as a bridge before the implantation of a durable left ventricular assist device (LVAD). Biventricular assist device (BIVAD)-support duration was 9 and 15 days and both of the patients were successfully bridged to a durable LVAD. As our BIVAD-concept is groin-free, the patients started full mobilization as early as they were weaned from the respirator 2 days after the BIVAD-implantation. ECPELLA 2.0 provides a high cardiac output, right and left ventricular unloading with end-organ recovery and a possibility of administration of a membrane oxygenator. There were no device-related complications. CONCLUSION The ECPELLA 2.0 biventricular support concept for patients suffering from an acute CS. Allows for rapid extubation, mobilization, and physical exercise while on full support. Additional application of a membrane oxygenator is easily feasible if required.
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Affiliation(s)
- Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Duisburg/Essen, Essen, Germany
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Duisburg/Essen, Essen, Germany
| | - Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Duisburg/Essen, Essen, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Leonie Grossekettler
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
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21
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Schmack B, Farag M, Kremer J, Grossekettler L, Brcic A, Raake PW, Kreusser MM, Goldwasser R, Popov AF, Mansur A, Karck M, Ruhparwar A. Results of concomitant groin-free percutaneous temporary RVAD support using a centrifugal pump with a double-lumen jugular venous cannula in LVAD patients. J Thorac Dis 2019; 11:S913-S920. [PMID: 31183170 DOI: 10.21037/jtd.2018.11.121] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Modern left ventricular assist devices (LVAD) have evolved to become standard of care in severe heart failure (HF) patients. Right HF (RHF) is a major complication responsible for early mortality. Several techniques for temporary right ventricular assist device (t-RVAD) have been described before, baring relevant disadvantages such as limited mobilization or the need for re-thoracotomy. We describe the results of an alternative technique for t-RVAD using the Tandem Heart™ with ProtekDuo™ cannula. Methods An institutional retrospective single centre outcome analysis was performed including all permanent LVAD recipients with concomitant groin-free t-RVAD support. Results Between October 2015 and September 2017, 11 patients (10 male, 90.9%) were included. Preoperative NYHA class was 3.8±0.75 and INTERMACS class 3.5±1.5. Four (36.4%) patients were already on mechanical circulatory support (MCS) at time of implantation with 4 (36.4%) patients already on inotropic support. All LVAD implantations were performed on-pump and 3 cases (27.3%) were re-do cases. Mean t-RVAD duration was 16.8±9.5 days. Ten patients (90.9%) could be weaned from temporary RVAD support, 1 patient deceased on support. Mean ICU stay was 23.8±16.5 days, while 30-day survival was 72.7%. Follow-up was complete with 214.7±283 days. Three patients (27.3%) died following multi-organ failure (MOF), 1 patient (9.1%) following intracranial bleed 12 days after t-RVAD explantation. No severe t-RVAD associated complications were observed. Conclusions Our technique allows for safe groin-free t-RVAD providing all advantages of percutaneous implantation including complete mobilization and bedside explantation without any need for operation.
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Affiliation(s)
- Bastian Schmack
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Mina Farag
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Jamila Kremer
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Leonie Grossekettler
- Department of Internal Medicine III, Cardiology, Angiology, Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Andreas Brcic
- Department of Anaesthesiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Cardiology, Angiology, Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Cardiology, Angiology, Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ranny Goldwasser
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Aron-Frederik Popov
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Ashham Mansur
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
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