Outcomes of venopulmonary arterial extracorporeal life support as temporary right ventricular support after left ventricular assist implantation

Abstract

In critically unwell patients requiring temporary biventricular support, planned venopulmonary arterial extracorporeal life support provides acceptable outcomes, similar to durable biventricular assist device support. Requirement for venopulmonary arterial extracorporeal life support is more determined by the level of preoperative acuity than echocardiographic or hemodynamic parameters.

Choosing Between Left Ventricular Assist Devices and Biventricular Assist Devices

“…[45] While promising, survival rates with more durable RVAD support systems remain similar to those with BiVAD support. [46,47] Nonetheless, owing to the novelty of these interventions, improvements in survival and wean rates can be expected with improved patient selection and postoperative management.…”

Outcome of right ventricular assist device implantation following left ventricular assist device implantation: Systematic review and meta-analysis

“…The main finding of our analysis is that temporary RVAD implantation following LVAD is associated with decreased in-hospital, as well as short-term survival as compared to isolated LVAD implantation (Figures 2 and 3). 1,[14][15][16][17] Similar conclusions regarding the mid-term survival can be drawn, where the implementation of temporary RVAD at index intervention was associated with reduced survival. 9,[18][19][20][21] Nevertheless, it seems that the implementation of temporary RVAD at the time of LVAD implantation is associated with a worse outcome.…”

“…26 Regarding hemodynamic variables evaluating pre LVAD right ventricular performance, we found the RAP in the LVAD/RVAD cohort, to be higher when compared to the LVAD cohort. 16,17,24,[27][28][29][30][31] The same may be stated for the central venous pressure, coupled with a lower pulmonary artery pressure. 1,9,[14][15][16]18,19,21,24,27,28,[30][31][32][33][34][35] The relation between RAP and PAPP (and/or relation to the PCWP) was not evaluated in any of the reports examined.…”

“…Author Author LVAD LVAD/RVAD Shehab et al 16 9.3 (4.6-18.0) Schmack et al 41 27.3 (9.7-56.6) Yoshioka et al 15 2.9 (1.5-5.6) Khorsandi et al 17 14.0 (6.6-27.3) Takeda et al 14 9.5 (6.4-13.9) Bhama et al 40 23.8 (13.5-38.5) Charisopoulou et al 28 nr Shah et al 42 46.7 (24.8-69.9) Amsallem et al 27 nr Yoshioka et al 15 40.7 (24.5-59.3) Kurihara et al 33 nr Takeda et al 14 47.5 (32.9-62.5) Nitta et al 31 nr Samura et al 21 nr Capoccia et al 44 nr Charisopoulou et al 28 nr Deschka et al 29 nr Amsallemet al 27 nr Yost et al 32 nr Deschka et al 29 nr Patil et al 18 nr Yost et al 32 nr Cordtz et al 43 nr Patil et al 18 nr Wang et al 24 nr Wang et al 24 nr Pettinari et al 34 nr Kormos et al 1 nr Saito et al 35 nr Morgan et al 9 nr Drakos et al 30 nr Kormos et al 1 nr Dang et al 19 nr Morgan et al 9 nr Pooled estimate (95% CI) 6. 16 16.0 (8.9-26.8) Schmack et al 41 36.4 (15.8-75.0) Yoshioka et al 15 14.0 (10.0-19.3) Khorsandi et al 17 51.0 (29.5-72.5) Takeda et al 14 18.0 (0.0-39.5) Bhama et al 40 50.0 (29.0-71.0) Charisopoulou et al 28 21.0 (11.2-34.5) Shah et al…”

The right technology for the right ventricular dysfunction: Are we facing the right way?

“…1 Patients with severe RVF sometimes require a temporary right ventricular assist device (RVAD), with an incidence ranging from 5% to 33%. [2][3][4][5] Different technologies have been described to assist the right ventricle during RVF, such as extracorporeal membrane oxygenation (ECMO), surgical cannulation of the right atrium and the main pulmonary artery, 6 or total percutaneous RVAD implantation through the femoral and the jugular veins. 7 The limited experiences with these different RVAD models do not allow a wide application of these technologies.…”