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

Harano, Takashi; Chan, Ernest G.; Furukawa, Masashi; Santos, Pedro Reck dos; Morrell, Matthew R.; Sappington, Penny L.; Sánchez, Pablo G.

doi:10.21037/jtd-21-1199

Cited by 9 publications

(5 citation statements)

References 14 publications

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“…In conclusion, the patients that were treated with a right ventricular assist device (RVAD) using the Protek Duo cannula had comparably better survival rates and fewer complications than other tpRVAD systems [ 48 ]. This supports the fact that the Protek Duo cannula is a safe and feasible treatment for patients who may develop acute right heart failure after left ventricular assist device (LVAD) implantation [ 46 ].…”

Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 64%

“…This improves oxygenation and relieves both the right atrium and ventricle of the heart. Thus, it also helps prevent complications related to arterial cannulation in patients waiting for lung transplantation with end-stage lung disease, preventing peripheral arterial cannulation or central cannulation [ 42 , 46 ].…”

Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%

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The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

et al. 2023

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In the United States, about one million people are seen to visit the operating theater for cardiac surgery annually. However, nearly half of these visits result in complications such as renal, neurological, and cardiac injury of varying degrees. Historically, many mechanisms and approaches have been explored in attempts to reduce injuries associated with cardiac surgery and percutaneous procedures. Devices such as cardioplegia, mechanical circulatory support, and other methods have shown promising results in managing and preventing life-threatening cardiac-surgery-related outcomes such as heart failure and cardiogenic shock. Comparably, cardioprotective devices such as TandemHeart, Impella family devices, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) have also been proven to show significant cardioprotection through mechanical support. However, their use as interventional agents in the prevention of hemodynamic changes due to cardiac surgery or percutaneous interventions has been correlated with adverse effects. This can lead to a rebound increased risk of mortality in high-risk patients who undergo cardiac surgery. Further research is necessary to delineate and stratify patients into appropriate cardioprotective device groups. Furthermore, the use of one device over another in terms of efficacy remains controversial and further research is necessary to assess device potential in different settings. Clinical research is also needed regarding novel strategies and targets, such as transcutaneous vagus stimulation and supersaturated oxygen therapy, aimed at reducing mortality among high-risk cardiac surgery patients. This review explores the recent advances regarding the use of cardioprotective devices in patients undergoing percutaneous procedures and cardiac surgery.

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Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 64%

Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%

The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

et al. 2023

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“…Sinha et al also reported two cases in which a ProtekDuo was used as a bridge to heart-lung and LT ( 51 ). Harano et al reported outcomes of four patients with idiopathic pulmonary fibrosis who were placed on ProtekDuo in V-P configuration as a bridge to transplantation, all of whom underwent double LT ( 52 ). There was one in-hospital mortality due to superimposed pseudomonas pneumonia with influenza virus infection on postoperative day 97, while the other three were alive at 2-year follow up.…”

Section: Newer and Atypical Uses Of Protekduomentioning

confidence: 99%

ProtekDuo percutaneous ventricular support system—physiology and clinical applications

John,

Nabzdyk,

Chweich

et al. 2024

Ann Transl Med

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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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“…There is also a data suggesting an association between denovo HLA-sensitization and ECMO bridging [40 & ]. Newer variations on ECLS have begun to gain traction, including the oxygenated right ventricular assist device (oxy-RVAD) to provide both oxygenation and right heart support [41][42][43]. It has been our practice for actively listed patients requiring endotracheal intubation who are deemed inappropriate for ECLS to undergo an early tracheostomy, allowing for active participation in physical therapy [44].…”

Section: Bridgingmentioning

confidence: 99%

Optimizing the prelung transplant candidate

Pagteilan,

Atay

2023

Current Opinion in Organ Transplantation

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Purpose of review Lung transplant outcomes are impacted by multiple modifiable risk factors. Candidate deterioration on the wait list remains problematic. Innovative technology and strategies to identify and impact pretransplant morbidity have improved short- and long-term outcomes. We focus our review on recent advances in pretransplant recipient assessment and optimization. Recent findings Advancements in recipient management have focused on risk factor identification for adverse outcomes and the development of a lung transplant specific frailty assessment. Early surgical correction of gastroesophageal reflux disease (GERD), including the use of partial fundoplication in the setting of esophageal dysmotility, leads to improvements in graft function/longevity. New evidence supports expanding criteria for extracorporeal life support as a bridge to transplant. Summary Candidate optimization requires early intervention to limit functional deterioration potentially contributing to adverse outcomes. Frailty can be identified with a transplant specific frailty assessment, and positively impacted with dedicated rehabilitation. Pretransplant frailty is reversible following transplant and should be considered in the context of overall fitness at the time of candidate selection. Invasive support modes including extracorporeal membrane oxygenation (ECMO) are appropriate to preserve strength and mobility, with awake, ambulatory ECMO preferred. The deleterious effect of GERD on graft function can be managed with early fundoplication over medical management alone.

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

Cited by 9 publications

References 14 publications

The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

ProtekDuo percutaneous ventricular support system—physiology and clinical applications

Optimizing the prelung transplant candidate

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