Right Ventricular Assist Device Implantation - A New Transcutaneous Approach

Abstract

The necessity for a secondary right heart assist device (RVAD) is a disastrous complication in left ventricular assist device (LVAD) support with respect to both complications and outcome. We have developed a new technique for inflow and outflow cannulation via a transcutaneous cannula in the femoral vein and a prosthesis-supported arterial cannula into the pulmonary artery, which does not necessitate rethoracotomy for device explantation. In addition to the simplified RVAD removal this transcutaneous approach may reduce the complications in patients requiring RVAD support.

Mechanical Circulatory Support for Right Heart Failure: Current Technology and Future Outlook

“…Various surgical approaches have been reported to achieve a less invasive device insertion (69,70,74). The invasive device implantation, including median sternotomy and thoracotomy, requires extensive surgery and highly specialized cardiac surgeons.…”

“…A general categorization of the RVADs mentioned in this manuscript, according to their functionality, technical configuration, and duration and type of support, is summarized in Table 4. Recent percutaneous support has allowed minimally invasive insertion via peripheral vessels-femoral or jugular vein-avoiding extensive dissection of cardiac adhesion and cardiopulmonary bypass (44,(68)(69)(70). Despite the usefulness of current percutaneous mechanical support systems, their complications, such as bleeding at the insertion site and potential thrombus formation in the catheter, have limited their use as short-to intermediate-term support or in emergency scenarios such as in cardiogenic shock.…”

“…This invasiveness therefore limits the benefits of this therapy to critically ill patient groups. Various surgical approaches have been reported to achieve a less invasive device insertion (69,70,74). However, complications resulting from the device intrinsic configurations, such as bleeding for some transcutaneous devices or thromboembolism in the cannulae, have slowed the uptake of RVADs.…”

Percutaneous Mechanical Circulatory Support Devices: Systems and Clinical Options

“…For several decades the volume administration to maintain RV preload, the vasodilators to decrease RV afterload and the inotropes to ameliorate RV contractility have been used in clinical practice [1][2][3][4][5][21][22][23][24][25][26][27]. The in-hospital mortality is high in patients with RV failure that is refractory to maximal medical treatment [1][2][3][4][5][21][22][23][24][25][26][27]. With the TandemHeart, the percutaneous right ventricular assist device (RVAD) support has become a reality [21].…”

“…Possible complications are tamponade, vascular injury, liver failure, injury to the tricuspid and pulmonic valves. The other extracorporeal devices used in the clinical practice are the Levitronix CentriMag (Abbott), currently, while the Rotaflow (Maquet) and the Abiomed AB 5000 (Abiomed), historically [23][24][25][26][27]. It is important to choose the adequate sizing for inflow and Figure 3.…”