The ProtekDuo in Percutaneous Peripheral Venopulmonary-Arterial ECMO and PROpella Configuration for Cardiogenic Shock with Biventricular Failure

Maybauer, Marc O.; Swol, Justyna; Sharif, Ammar; Benson, Clayne; Brewer, Justin

doi:10.4103/aca.aca_150_22

Cited by 5 publications

(1 citation statement)

References 6 publications

(7 reference statements)

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“…Of late, percutaneous, temporary, axial flow MCS devices such as Impella have been used as effective LV vents in patients on V-A ECMO, a concept referred to as ECpella. Ruhparwar et al improved upon this concept with ECpella 2.0/PROpella, a groin-free MCS consisting of a surgically implanted full-flow axial flow pump (Impella 5.0/5.5) as an LVAD in combination with the TandemHeart/ProtekDuo system as an RV MCS ( 44 , 45 ). This allows for complete biventricular support with the option to splice in an oxygenator if needed.…”

Section: Newer and Atypical Uses Of Protekduomentioning

confidence: 99%

ProtekDuo percutaneous ventricular support system—physiology and clinical applications

John,

Nabzdyk,

Chweich

et al. 2024

Ann Transl Med

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The ProtekDuo (LivaNova, London, UK) cannula is a dual-lumen device, typically inserted into the right internal jugular (IJ) vein through a percutaneous approach, with fluoroscopy or ultrasound guidance. When connected to a pump, such as the TandemHeart (LivaNova, London, UK) or CentriMag (Abbott, Pleasanton, CA, USA), it can function as a right ventricular (RV) mechanical circulatory support (MCS). When an oxygenator is also added [veno-pulmonary (V-P)], it can provide extracorporeal membrane oxygenation (ECMO) support. This review aims to provide a comprehensive overview of the device’s physiology and clinical applications. In the setting of RV failure (RVF), the ProtekDuo cannula, with its outflow in the main pulmonary artery (PA), can bypass the failing RV, improving pulmonary flow, left atrial (LA) filling pressures, and left ventricular (LV) preload. This can also reduce ventricular interdependence and leftward shift of the interventricular septum that occurs in RVF. In this review, the key sections expand on the use of the ProtekDuo cannula in the management of critically ill patients, specifically, the use of ProtekDuo for RV myocardial infarction (MI) RVF, LV assist device (LVAD) implantation-associated RVF, RVF post-heart transplantation, temporary biventricular MCS as bridge to recovery (ECpella 2.0 or PROpella), biventricular support as bridge to recovery or decision, isolated LV failure, post lung transplantation (LT) care, and other miscellaneous clinical scenarios. ProtekDuo is an important tool in the armory of RVF management. The ProtekDuo system is expected to gain more popularity given its clear advantages such as groin-free approach allowing for mobility, easy percutaneous deployment, compatibility with various pumps and oxygenators, and the versatility to be integrated in numerous configurations. In an era of expanding MCS options, further research is needed to better understand the optimal tool for specific patient subsets.

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Section: Newer and Atypical Uses Of Protekduomentioning

confidence: 99%

ProtekDuo percutaneous ventricular support system—physiology and clinical applications

John,

Nabzdyk,

Chweich

et al. 2024

Ann Transl Med

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Technique for Weaning From Peripheral Venopulmonary Extracorporeal Membrane Oxygenation in Combined Cardiopulmonary Failure

Brewer,

Maybauer

2024

ASAIO Journal

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Venopulmonary (VP) extracorporeal membrane oxygenation (ECMO) is a mode capable of supporting both pulmonary and right ventricular (RV) functions. Weaning patients from VP ECMO requires careful assessment of both RV and respiratory system recovery, which may occur at different rates. The weaning strategy described herein begins with weaning of respiratory ECMO support, followed by discontinuation of RV support. We also discuss situations in which the standard weaning strategy may require modification.

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The Role of TandemHeart^TMcombined with ProtekDuo^TMas Right Ventricular Support Device: A Simulation Approach

De Lazzari,

Badagliacca,

Capoccia

et al. 2024

Preprint

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Right ventricular failure increases short-term mortality in the setting of acute myocardial infarction, cardiogenic shock, advanced left-sided heart failure and pulmonary hypertension. Right ventricular failure remains quite a challenging condition to manage in view of its complex background and still incomplete understanding of its pathophysiology. Percutaneous and surgically implanted right ventricular assist devices (RVADs) have been investigated in different clinical settings. The use of the ProtekDuoTM(LivaNova, London, UK) is currently a promising approach due to its features such as groin-free approach leading to early mobilisation, easy percutaneous deployment, compatibility with different pumps and oxygenators, and adaptability to different configurations. The aim of this work was to simulate the behaviour of the TandemHeartTMpump applied ″in series″ and ″in parallel″ mode and the combination of TandemHeartTMand ProtekDuoTM cannula as right ventricular assist device using CARDIOSIM©software simulator platform. The effects induced on the main hemodynamic and energetic variables were analysed for both the right atrial-pulmonary arterial and right ventricular-pulmonary arterial configuration with different pump rotational speed and following Milrinone administration. The TandemHeartTMincreased right ventricular end systolic volume by 10%, larger increases were evident for higher speeds (6000 and 7500 rpm) and connections with 21 Fr inflow and 17 Fr outflow cannula, respectively. Both TandemHeartTMand ProtekDuoTMsupport increased left ventricular preload. When different RVAD setting were used, Milrinone therapy increased the left ventricular pressure-volume area and deceised the right pressure-volume area slightly. A reduction in oxygen consumption (demand) was observed with reduced right stroke work and pressure volume area and increased oxygen supply (coronary blood flow).

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The ProtekDuo in Percutaneous Peripheral Venopulmonary-Arterial ECMO and PROpella Configuration for Cardiogenic Shock with Biventricular Failure

Cited by 5 publications

References 6 publications

ProtekDuo percutaneous ventricular support system—physiology and clinical applications

ProtekDuo percutaneous ventricular support system—physiology and clinical applications

Technique for Weaning From Peripheral Venopulmonary Extracorporeal Membrane Oxygenation in Combined Cardiopulmonary Failure

The Role of TandemHeart^TMcombined with ProtekDuo^TMas Right Ventricular Support Device: A Simulation Approach

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The ProtekDuo in Percutaneous Peripheral Venopulmonary-Arterial ECMO and PROpella Configuration for Cardiogenic Shock with Biventricular Failure

Cited by 5 publications

References 6 publications

ProtekDuo percutaneous ventricular support system—physiology and clinical applications

ProtekDuo percutaneous ventricular support system—physiology and clinical applications

Technique for Weaning From Peripheral Venopulmonary Extracorporeal Membrane Oxygenation in Combined Cardiopulmonary Failure

The Role of TandemHeartTMcombined with ProtekDuoTMas Right Ventricular Support Device: A Simulation Approach

Contact Info

Product

Resources

About

The Role of TandemHeart^TMcombined with ProtekDuo^TMas Right Ventricular Support Device: A Simulation Approach