The novel ProtekDuo ventricular assist device: Configurations, technical aspects, and present evidence

Abstract

The ProtekDuo, single site dual lumen cannula can be used in a multitude of configurations. In the medical literature, the ProtekDuo is described as right ventricular assist device (RVAD), as left ventricular assist device (LVAD), as biventricular assist device (BiVAD) when combined with an Impella device or other LVAD’s, as double lumen drainage cannula on cardiopulmonary bypass (CPB), as RVAD with oxygenator, in veno-pulmonary (V-P) ECMO configuration, venovenous-pulmonary (VV-P) ECMO configuration with additional drainage cannula, and in veno-venopulmonary (V-VP) ECMO configuration as double lumen return cannula. Improvements in flow and oxygenation have been recognized in various settings and need further scientific evaluation. We summarized the above-mentioned configurations, technical aspects, and the present literature available for the ProtekDuo.

The ProtekDuo for percutaneous V-P and V-VP ECMO in patients with COVID-19 ARDS

“…Default is the V-P configuration with blood drainage from the RA and blood return into the PA. An average blood flow of 4.5 LPM may be achieved. 4 …”

“…Default is the V-P configuration with blood drainage from the RA and blood return into the PA. An average blood flow of 4.5 LPM may be achieved. 4 The V-P ECMO configuration represents the default ProtekDuo position. Adding an oxygenator to the circuit mimics combined RVAD and V-V ECMO support.…”

“…Therefore, with the flow into the PA, the right ventricle (RV) can be bypassed, and the oxygenated blood flow used as veno-pulmonary (V-P) ECMO support. 4 To date, literature concerning the ProtekDuo, particularly in the setting of patients with ARDS secondary to COVID-19 infection, is very limited. Over the last 2 years we have been proactive in managing this patient cohort and have frequently adjusted the circuit configuration dependent upon oxygen requirements or right heart failure.…”

The ProtekDuo cannula for extracorporeal membrane oxygenation: A game changer in COVID‐19!

“…The ProtekDuo is a single site, dual lumen cannula that may be used in a multitude of configurations. 1 It was initially designed as right ventricular assist device (RVAD) cannula that comes in conjunction with the TandemHeart pump (LivaNova PLC, London, UK). It has also been described as RVAD with oxygenator, left ventricular assist device (LVAD), biventricular assist device when combined with LVAD's, as double lumen drainage cannula for cardiopulmonary bypass, and in various extracorporeal membrane oxygenation (ECMO) configurations with veno‐pulmonary (V‐P) as its default position.…”

“…It has also been described as RVAD with oxygenator, left ventricular assist device (LVAD), biventricular assist device when combined with LVAD's, as double lumen drainage cannula for cardiopulmonary bypass, and in various extracorporeal membrane oxygenation (ECMO) configurations with veno‐pulmonary (V‐P) as its default position. 1 As the onset of the COVID 19 pandemic produced much longer ECMO run times than physicians were accustomed to, the incidence of right heart failure increased as a logic consequence and the ProtekDuo was used more frequently as RVAD with oxygenator even as primary device to initiate ECMO. 2 According to a systematic review of 28 observational studies including 4218 COVID‐19 patients performed by Mariani et al, the use of mechanical circulatory support (MCS) for cardiocirculatory compromise has been reported only in 7.3% of COVID‐19 patients requiring extracorporeal life support, which is a lower percentage compared to the incidence of any severe cardiocirculatory complication.…”