Acute right heart failure: future perspective with the PERKAT RV pulsatile right ventricular support device

Abstract

Acute right heart failure is associated with impaired prognosis in cardiogenic shock. Since most pharmacological therapies are not evaluated for the failing right ventricle, or even contraindicated, there is a need for rapid minimal invasive circulatory right heart support. The PERKAT RV is such a device for acute therapy in congestive heart failure. It reduces the central venous pooling by pumping blood from the inferior vena cava into the pulmonary artery with flow rates of up to 4 litres/min. The device was evaluated in an animal model of acute pulmonary embolism after careful in vitro tests. PERKAT RV increased cardiac output by 59% in sheep suffering from acute right heart failure. We await the first human implantation in the near future. Based on the PERKAT concept, future devolvement will also focus on left heart support.

First‐in‐man successful use of the SPECTRUM percutaneous dual‐stage right ventricle and right atrium to pulmonary artery ventricular assist device

“…An area of active research for right ventricular support is the use of pulsatile versus nonpulsatile mechanical support. 9 This concept is heavily studied for left-sided durable support, however, data from animal experiments suggest that under continuous RV mechanical support there may be an increased risk of extravascular lung water accumulation, pulmonary edema, and pulmonary hemorrhage. Taguchi et al 10 demonstrated in 14 mongrel dogs that nonpulsatile perfusion of the lungs during a 10-h bypass period resulted in a greater tendency of lung water to accumulate.…”

Mechanical circulatory support: complications, outcomes, and future directions

“…Balloon deflation (within the cage in the vena cava) pulls blood into the cage chamber, and balloon inflation propels that collected blood through the cage, into the catheter, and then into the pulmonary thus "bypassing" the need for RV systolic function to propel blood into the lungs. 64 There are no published reports on the use of the PERKAT in humans at this time.…”

“…A nitinol cage with outflow valves is deployed in the inferior vena cava and a pigtail catheter that arises from the cage is placed through the right atrium, tricuspid valve, RV, pulmonic valve, and into the pulmonary artery. Balloon deflation (within the cage in the vena cava) pulls blood into the cage chamber, and balloon inflation propels that collected blood through the cage, into the catheter, and then into the pulmonary artery, thus “bypassing” the need for RV systolic function to propel blood into the lungs 64. There are no published reports on the use of the PERKAT in humans at this time.…”

Keep the Right in Mind—A Focused Approach to Right Ventricle-Predominant Cardiogenic Shock

“…The PERKAT ® RV pulsatile right ventricular support device augments the efficacy of the IABP device, with a pump chamber connected to an outlet tube and a pulmonary trunk, bypassing the right heart. Though showing a promising efficacy, tests have been limited to animal models, showing an increased cardiac output by 59% in sheep suffering from acute RHF [ 86 , 87 ].…”