Oxy‐RVAD support for lung transplant in the absence of inferior vena cava

Joubert, Kyla; Harano, Takashi; Pilewski, Joseph M.; Sánchez, Pablo G.

doi:10.1111/jocs.15040

Cited by 6 publications

(4 citation statements)

References 6 publications

(8 reference statements)

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“…Even though the use of the ProtekDuo cannula for right heart failure is becoming increasingly widely accepted (4,5), the use of the ProtekDuo as a bridge to lung transplantation is rarely reported in the literature (6,7). The use of the ProtekDuo cannula either in the intra-operative or posttransplant setting has been recently reported (8,9), as well as centrally cannulated oxyRVAD bridging to lung transplant (10,11). Therefore, oxyRVAD bridging to lung transplantation with the ProtekDuo cannula could be a potential bridging method for critically ill patients with end-stage lung disease preventing peripheral arterial cannulation or central cannulation.…”

Section: Discussionmentioning

confidence: 99%

Oxygenated right ventricular assist device with a percutaneous dual-lumen cannula as a bridge to lung transplantation

Harano¹,

Chan²,

Furukawa³

et al. 2022

J Thorac Dis

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Background: Oxygenated right ventricular assist device (oxyRVAD) placement has become more streamlined with the introduction of the dual-lumen pulmonary artery cannula. Peripherally cannulated oxyRVAD may provide oxygenation support with right heart support as an alternative to venoarterial extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation.Methods: A single-institution, retrospective analysis was performed on patients placed on oxyRVAD with a dual-lumen pulmonary artery cannula with the intention of bridging to lung transplantation in 2019.Results: Four patients with idiopathic pulmonary fibrosis were placed on oxyRVAD as a bridge to transplantation. Two patients were extubated and ambulated while waiting for a lung offer, and two patients required conversion to venoarteriovenous ECMO (VAV ECMO) from oxyRVAD. The median waiting time for extracorporeal life support (ECLS) was 42 h. All patients underwent double lung transplantation.Two patients stayed on oxyRVAD, and one patient was placed on venovenous ECMO (VV ECMO) after transplantation. Primary graft dysfunction score at 72 h after transplantation was grade 1 in three patients and grade 3 in one patient.Conclusions: Peripherally cannulated oxyRVAD with percutaneous dual-lumen venous cannula could be an ambulatory bridge for lung transplantation. It is unknown whether oxyRVAD is feasible as a long-term bridge to lung transplantation.

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Section: Discussionmentioning

confidence: 99%

Oxygenated right ventricular assist device with a percutaneous dual-lumen cannula as a bridge to lung transplantation

Harano¹,

Chan²,

Furukawa³

et al. 2022

J Thorac Dis

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“…The following year, Aggarwal et al described a patient with combined cardiogenic shock due to right ventricular failure (RVF) and hypoxic respiratory failure, treated with the ProtekDuo® cannula as part of an ECMO system that provided both right ventricle (RV) and respiratory support [2]. Subsequently, the application of this device has expanded, primarily for the management of RVF, both with [3][4][5][6][7][8][9][10] and without [8,9,11] an ML for simultaneous respiratory failure treatment. The adoption of the cannula has grown, not only within RVAD systems but also as a component of ECMO in various configurations for respiratory, cardiocirculatory, or combined support [12].…”

Section: Introductionmentioning

confidence: 99%

Adaptive ECMO Therapeutics: The Integral Role of the ProtekDuo® Cannula

Brewer,

Dacey,

O. Maybauer

2024

Evolving Therapies and Technologies in Extracorporeal Membrane Oxygenation [Working Title]

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This chapter provides an in-depth analysis of the ProtekDuo® (LivaNova, London) dual-lumen cannula’s application in extracorporeal membrane oxygenation (ECMO), focusing on the procedural techniques of cannulation, weaning, and decannulation. The discussion will provide the step-by-step methodologies for inserting and removing the cannula, drawing from current clinical practices. Further, the chapter will explore the range of ECMO configurations that the ProtekDuo® cannula enables. It will examine how these configurations can be tailored to the evolving clinical requirements of patients, thereby enhancing the adaptability and effectiveness of ECMO therapy. This analysis will be anchored in the latest literature, providing a contemporary overview of patient outcomes and current practices. Lastly, the chapter will project into the future of the cannula technology for venopulmonary (VP) ECMO and other configurations. It will review ongoing research and development efforts, speculate on potential technological breakthroughs, and discuss the implication of these innovations for clinical practice. This forward-looking perspective will aim to inform and inspire continued advancement in ECMO therapy and technology.

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“…In this configuration, any pump and oxygenator can be attached to the cannula. With an oxygenator this configuration is called an oxy‐RVAD 6,7 . One of the challenges associated with these cannulation strategies is that blood that returns from the thebesian veins as well as blood that circumvents the RA into the RV may not be adequately drained by the single right atrial drainage port.…”

Section: Introductionmentioning

confidence: 99%

“…With an oxygenator this configuration is called an oxy-RVAD. 6,7 One of the challenges associated with these cannulation strategies is that blood that returns from the thebesian veins as well as blood that circumvents the RA into the RV may not be adequately drained by the single right atrial drainage port. In December 2021, the Food and Drug Administration approved a new dual-stage dual lumen single cannula RVAD manufactured by Spectrum (Figures 1 and 2).…”

mentioning

confidence: 99%

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

Usman¹,

Spelde²,

Olia³

et al. 2022

Journal of Cardiac Surgery

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Background: Over the past decade, several minimally invasive mechanical support devices have been introduced into clinical practice to support the right ventricle (RV). Percutaneous cannulas are easy to insert, minimally invasive, and treat acute RV failure rapidly. In December 2021, the Food and Drug Administration approved a new 31 French dual lumen single cannula for use as a right ventricular assist device. Aims: Descirbe the use of the new dual lumen percutaneous right ventricular assist device (RVAD) cannula. Material and Methods: Deployment of the RVAD can be done surgically or percutaneously. This cannula, manufactured by Spectrum, is dual staged. It has inflow ports positioned both in the right atrium (RA) as well as the RV for maximal drainage of the right heart. The distal end of the cannula which includes the outflow port is positioned in the pulmonary artery (PA). Results: Deployment of the Spectrum RVAD can be done percutaneously with transesophageal and flouroscopy guidence. Cannulation requires requisite wire skills in order to navigate into the main pulmonary artery. Utilization of this cannula can be done in acute RV failure secondary to ischemia, post cardiotomy shock, acute respiratory failure or other causes of isolated RV failure. Discussion: The dual stage drainage design optimizes venous drainage as well as limits suck-down events. Theoretically, direct RV decompression also decreases RV dilation and wall tension, and facilitates improved transmural pressure gradient to reduce RV strain. Conclusion: Here we describe the first-in-man successful use of the dual-stage RA and RV to PA Spectrum cannula in a patient with severe COVID acute respiratory distress syndrome and acute right ventricular failure, bridged to recovery.

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Oxy‐RVAD support for lung transplant in the absence of inferior vena cava

Cited by 6 publications

References 6 publications

Oxygenated right ventricular assist device with a percutaneous dual-lumen cannula as a bridge to lung transplantation

Oxygenated right ventricular assist device with a percutaneous dual-lumen cannula as a bridge to lung transplantation

Adaptive ECMO Therapeutics: The Integral Role of the ProtekDuo® Cannula

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

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