Results of concomitant groin-free percutaneous temporary RVAD support using a centrifugal pump with a double-lumen jugular venous cannula in LVAD patients

Abstract

Background: Modern left ventricular assist devices (LVAD) have evolved to become standard of care in severe heart failure (HF) patients. Right HF (RHF) is a major complication responsible for early mortality. Several techniques for temporary right ventricular assist device (t-RVAD) have been described before, baring relevant disadvantages such as limited mobilization or the need for re-thoracotomy. We describe the results of an alternative technique for t-RVAD using the Tandem Heart™ with ProtekDuo™ cannula. Methods: An institutional retrospective single centre outcome analysis was performed including all permanent LVAD recipients with concomitant groin-free t-RVAD support. Results: Between October 2015 and September 2017, 11 patients (10 male, 90.9%) were included. Preoperative NYHA class was 3.8±0.75 and INTERMACS class 3.5±1.5. Four (36.4%) patients were already on mechanical circulatory support (MCS) at time of implantation with 4 (36.4%) patients already on inotropic support. All LVAD implantations were performed on-pump and 3 cases (27.3%) were redo cases. Mean t-RVAD duration was 16.8±9.5 days. Ten patients (90.9%) could be weaned from temporary RVAD support, 1 patient deceased on support. Mean ICU stay was 23.8±16.5 days, while 30-day survival was 72.7%. Follow-up was complete with 214.7±283 days. Three patients (27.3%) died following multi-organ failure (MOF), 1 patient (9.1%) following intracranial bleed 12 days after t-RVAD explantation. No severe t-RVAD associated complications were observed. Conclusions: Our technique allows for safe groin-free t-RVAD providing all advantages of percutaneous implantation including complete mobilization and bedside explantation without any need for operation.

MitraClip implantation followed by insertion of a left ventricular assist device in patients with advanced heart failure

“…Further, major post‐operative complications as defined by INTERMACS, 26 and duration of inotropic support were without a significant difference between the MC and no‐MC groups. Remarkably, there was a trend towards higher incidence of post‐operative RV failure as defined by EUROMACS ( European Registry for Patients with Mechanical Circulatory Support ) 27,28 in the MC group ( P = 0.077), along with a more frequent need for RV support 28,29 and a significantly higher duration of nitric oxygen (NO) ventilation in the MC group ( Table 4 ), pointing to a higher peri‐operative tension on the RV in the MC group compared with the no‐MC group. Functional as well as laboratory and echocardiography parameters did not display differences between the MC and no‐MC groups at one year after LVAD implantation ( Table 5 ).…”

Ventricular assist device for a coronavirus disease 2019‐affected heart

“…Owing to the patient's status, the results of a TAH procedure were regarded as unfavourable in the patient as surgical trauma would have been unequally larger than LVAD surgery. Within our heart failure heart team, we assessed this patient to be a good candidate for durable LVAD support with temporary groin‐free RVAD, 3 assuming the acute COVID‐19 infection to be one major and reversible issue impairing the RV. However, the high haemocompatibility of the HeartMate 3 device remains outstanding.…”

“…At that time, NT-proBNP was 163 837 pg/mL, C-reactive protein raised to 24.5 mg/dL, IL-6 to 124 pg/mL, and PCT to 7.73 ng/mL ( Table S1). The patient was referred to heart surgery with LVAD as therapeutic bridge-to-transplant option, percutaneous temporary right ventricular assist device (RVAD) implantation, 3 and tricuspid repair on Hospital Day 13. Hereafter, weaning from the RVAD was successful 2 weeks after implantation.…”

ECPELLA 2.0—Minimally invasive biventricular groin‐free full mechanical circulatory support with Impella 5.0/5.5 pump and ProtekDuo cannula as a bridge‐to‐bridge concept: A first‐in‐man method description

“…On the first postoperative day (POD), the patient was weaned from the respirator and full mobilization continued. The temporary RVAD was weaned according to our protocols 10 and explanted at the bedside on POD 5.…”