Temporary percutaneous right ventricular support using a centrifugal pump in patients with postoperative acute refractory right ventricular failure after left ventricular assist device implantation

Abstract

OBJECTIVE: Acute right ventricular (RV) failure is a life-threatening condition with a poor prognosis, and sometimes the use of mechanical circulatory support is inevitable. In this article, we describe our experience using a centrifugal pump as a temporary percutaneous right ventricular assist device (RVAD) in patients with postoperative acute refractory RV failure after left ventricular assist device (LVAD) implantation. METHODS:We retrospectively reviewed eight consecutive patients with acute RV failure who underwent temporary percutaneous RVAD implantation using a centrifugal pump after LVAD implantation between April 2008 and February 2011. A Dacron graft was attached to the main pulmonary artery and passed through a subxiphoid exit, where the outflow cannula was inserted. The inflow cannula was percutaneously cannulated using Seldinger's technique in the femoral vein. The chest was definitely closed. The technique allowed bedside removal, avoiding chest re-opening. RESULTS:The median patient age was 52 years (range: 41-58). The median duration of support was 14 days (range: 12-14). RV systolic function improved; central venous pressure and mean pulmonary artery pressure decreased significantly after RVAD support. In three patients, an oxygenator was integrated into the RVAD due to impaired pulmonary function. Six patients were successfully weaned. Five patients survived to hospital discharge. Technical problems or serious complications concerning decannulation were not observed. CONCLUSION:This report suggests that implantation of temporary percutaneous RVAD using a centrifugal pump is a safe alternative in the treatment of postoperative acute refractory RV failure. Ease of device implantation, weaning, explantation, and limited number of complications justify a liberal use.

Left ventricular vs. biventricular mechanical support: Decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation

“…Temporary mechanical RV support directly after LVAD implantation is indicated in patients with overt RVF despite maximal medical management during or immediately after weaning from cardiopulmonary bypass and in high risk patients for post-LVAD RVF [58,[64][65][66][67]. The advantage of adding an RVAD is total control of the circulation, particularly valuable in the presence of circulatory collapse or ventricular arrhythmias [68].…”

Ventricular Assist Device Implant in the Elderly Is Associated With Increased, but Respectable Risk: A Multi-Institutional Study

“…Unfortunately, there still is not a widely applicable CF RVAD platform that is available. In the meantime, it may be possible to utilize temporary right ventricular support to bridge patients with intermediate risk for right ventricular failure for a short period of time with a temporary CF RVAD tunneled through the chest wall [21, 22]. This strategy to unload the right ventricle may allow the ventricle to recover enough to support the LVAD long term.…”

Hospital costs fell as numbers of LVADs were increasing: experiences from Oslo University Hospital

“…Efficacy and safety of LVAD have been reported in several studies [19,20]. However, there is no strong evidence that LVAD is a cost-effective choice of treatment for bridge to transplant patient group [21,22].…”