Percutaneous RVAD with the Protek Duo for severe right ventricular primary graft dysfunction after heart transplant

Carrozzini, Massimiliano; Merlanti, Bruno; Olivieri, Guido; Lanfranconi, Marco; Bruschi, Giuseppe; Mondino, Michele; Russo, Claudio

doi:10.1016/j.healun.2021.03.016

Cited by 22 publications

(27 citation statements)

References 7 publications

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“…The Impella RP was evaluated in the nonrandomized RECOVER RIGHT study that showed significant improvement in cardiac index and decrease in central venous pressure with 73% 30-day survival [27]. Studies of the Protek Duo cannula have been limited to several small case series showing haemodynamic improvements and the ability to wean support in a selected subset of patients [28,29].…”

Section: Temporary Right Ventricular Assist Devicesmentioning

confidence: 99%

The role of temporary mechanical circulatory support as a bridge to advanced heart failure therapies or recovery

Oren

Zilinyi²,

Lotan³

et al. 2022

Current Opinion in Cardiology

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Purpose of reviewTemporary mechanical circulatory support (tMCS) has become central in the treatment of refractory cardiogenic shock and can be used to bridge patients to durable MCS, heart transplant or recovery. This review will discuss contemporary data regarding bridging strategies utilizing tMCS.Recent findingsThere has been significant growth in tMCS use recently, driven by increased familiarity with tMCS devices, and increased experience with both implantation and management. Identifying goals of therapy at the time of therapy initiation can facilitate better outcomes. The three primary goals are bridge to recovery, bridge to heart transplantation or bridge to durable left ventricular assist device. Bridging to recovery requires adequate treatment of underlying conditions and optimization of haemodynamics. Bridging to heart transplantation has become more frequent following changes to the heart allocation policy. Despite early concerns, patients bridge with tMCS, including ventricular-arterial extracorporeal membrane oxygenation, do not appear to have worse posttransplant outcomes. When bridging to durable mechanical circulatory support, tMCS can be used to enhance end-organ dysfunction and improve perioperative outcomes. In situations in which none of these goals are attainable, palliative care plays a critical role to identify patient wishes and assist with withdrawal of care when necessary.SummaryThe use of tMCS, as a bridge to recovery or heart replacement therapy in patients with refractory cardiogenic shock has grown significantly over the past decade. Multiple device choices are available and must be chosen appropriately to address the specific situation and the goals of therapy.

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Section: Temporary Right Ventricular Assist Devicesmentioning

confidence: 99%

The role of temporary mechanical circulatory support as a bridge to advanced heart failure therapies or recovery

Oren

Zilinyi²,

Lotan³

et al. 2022

Current Opinion in Cardiology

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show abstract

“…In addition, when RV support is no longer necessary, the removal of the device requires surgical re-entry, or, in the case of a tunneled prosthetic graft, it entails prolonged retention of foreign material in-situ [ 17 ]. Recently, the ProtekDuo cannula has emerged as an attractive option for RV support in patients with left ventricular failure developing temporary RHF in different clinical settings (see Table 3 ) [ 11 , 12 , 13 , 18 , 19 , 20 ]. This double-lumen cannula offers all the well-known advantages of a totally percutaneous approach, together with the capability to provide >4 L per minute of blood flow.…”

Section: Discussionmentioning

confidence: 99%

Planned Combo Strategy for LVAD Implantation in ECMO Patients: A Proof of Concept to Face Right Ventricular Failure

Tarzia

Ponzoni

Pittarello

et al. 2022

JCM

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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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“…The ProtekDuo has also been used in the setting of primary graft dysfunction (PGD) after heart transplant when the PGD was attributed to isolated RV failure. Carrozzini described the application of the ProtekDuo in 3 such cases ( 76 ). All patients had normal pulmonary artery pressures and PVR prior to transplantation.…”

Section: The Evolution Of Percutaneous Right Ventricular Assist Devicesmentioning

confidence: 99%

“…All patients underwent uneventful initiation of pRVAD and a maximal flow of 4 L/min was achieved in all cases. All patients were successfully weaned from RVAD support and discharged without clinical or echocardiographic signs of RV dysfunction ( 76 ).…”

Section: The Evolution Of Percutaneous Right Ventricular Assist Devicesmentioning

confidence: 99%

Supporting the “forgotten” ventricle: The evolution of percutaneous RVADs

James

Smith

2023

Front. Cardiovasc. Med.

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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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Percutaneous RVAD with the Protek Duo for severe right ventricular primary graft dysfunction after heart transplant

Cited by 22 publications

References 7 publications

The role of temporary mechanical circulatory support as a bridge to advanced heart failure therapies or recovery

The role of temporary mechanical circulatory support as a bridge to advanced heart failure therapies or recovery

Planned Combo Strategy for LVAD Implantation in ECMO Patients: A Proof of Concept to Face Right Ventricular Failure

Supporting the “forgotten” ventricle: The evolution of percutaneous RVADs

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