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Successful use of temporary right ventricular support to avoid implantation of biventricular long-term assist device: a transcutaneous approach.
ASAIO J. 2011 Jul-Aug; 57(4):274-7.AJ

Abstract

Severe right ventricular (RV) failure after left ventricular assist device (LVAD) implantation is a serious complication with a poor prognosis. The most effective therapy for these patients is an upgrade to biventricular mechanical support. However, it is well recognized that primary and secondary biventricular ventricular assist device implantation is associated with higher mortality rates. We report on three patients with cardiogenic shock, who were provided on an emergency basis with a percutaneous extracorporeal life support (ECLS) system by the femoral vessels. After stabilization, a LVAD was implanted. To avoid secondary RV failure, the ECLS was switched to a transcutaneous RV assist device (RVAD) as a temporary RV support. The arterial cannula was removed from the femoral artery, and a prosthesis-supported cannula was sutured to the pulmonary artery and passed through a subxiphoid exit. The femoral vein cannula was left in situ. Both cannulae were connected to a centrifugal pump. Two patients could be weaned from the RVAD; the system was explanted under local anesthesia. One patient died due to internal bleeding. In conclusion, the ease of device implantation, weaning, and explantation justifies a liberal use of temporary RV support to avoid implantation of the problematic long-term biventricular assist devices.

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Authors+Show Affiliations

Haneya A
Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany. assadhaneya@web.de
Philipp A
No affiliation info available
Diez C
No affiliation info available
Metterlein T
No affiliation info available
Puehler T
No affiliation info available
Hilker M
No affiliation info available
Rupprecht L
No affiliation info available
Zausig Y
No affiliation info available
Schmid C
No affiliation info available
Hirt SW
No affiliation info available

MeSH

Administration, CutaneousAdultCathetersEchocardiographyHeart FailureHeart-Assist DevicesHemorrhageHumansMaleMiddle AgedMyocardial InfarctionProsthesis ImplantationShock, CardiogenicTreatment OutcomeVentricular Dysfunction, Right

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

21642843

Citation

Haneya, Assad, et al. "Successful Use of Temporary Right Ventricular Support to Avoid Implantation of Biventricular Long-term Assist Device: a Transcutaneous Approach." ASAIO Journal (American Society for Artificial Internal Organs : 1992), vol. 57, no. 4, 2011, pp. 274-7.
Haneya A, Philipp A, Diez C, et al. Successful use of temporary right ventricular support to avoid implantation of biventricular long-term assist device: a transcutaneous approach. ASAIO J. 2011;57(4):274-7.
Haneya, A., Philipp, A., Diez, C., Metterlein, T., Puehler, T., Hilker, M., Rupprecht, L., Zausig, Y., Schmid, C., & Hirt, S. W. (2011). Successful use of temporary right ventricular support to avoid implantation of biventricular long-term assist device: a transcutaneous approach. ASAIO Journal (American Society for Artificial Internal Organs : 1992), 57(4), 274-7. https://doi.org/10.1097/MAT.0b013e31821f2130
Haneya A, et al. Successful Use of Temporary Right Ventricular Support to Avoid Implantation of Biventricular Long-term Assist Device: a Transcutaneous Approach. ASAIO J. 2011 Jul-Aug;57(4):274-7. PubMed PMID: 21642843.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Successful use of temporary right ventricular support to avoid implantation of biventricular long-term assist device: a transcutaneous approach. AU - Haneya,Assad, AU - Philipp,Alois, AU - Diez,Claudius, AU - Metterlein,Thomas, AU - Puehler,Thomas, AU - Hilker,Michael, AU - Rupprecht,Leopold, AU - Zausig,York, AU - Schmid,Christof, AU - Hirt,Stephan W, PY - 2011/6/7/entrez PY - 2011/6/7/pubmed PY - 2011/10/20/medline SP - 274 EP - 7 JF - ASAIO journal (American Society for Artificial Internal Organs : 1992) JO - ASAIO J VL - 57 IS - 4 N2 - Severe right ventricular (RV) failure after left ventricular assist device (LVAD) implantation is a serious complication with a poor prognosis. The most effective therapy for these patients is an upgrade to biventricular mechanical support. However, it is well recognized that primary and secondary biventricular ventricular assist device implantation is associated with higher mortality rates. We report on three patients with cardiogenic shock, who were provided on an emergency basis with a percutaneous extracorporeal life support (ECLS) system by the femoral vessels. After stabilization, a LVAD was implanted. To avoid secondary RV failure, the ECLS was switched to a transcutaneous RV assist device (RVAD) as a temporary RV support. The arterial cannula was removed from the femoral artery, and a prosthesis-supported cannula was sutured to the pulmonary artery and passed through a subxiphoid exit. The femoral vein cannula was left in situ. Both cannulae were connected to a centrifugal pump. Two patients could be weaned from the RVAD; the system was explanted under local anesthesia. One patient died due to internal bleeding. In conclusion, the ease of device implantation, weaning, and explantation justifies a liberal use of temporary RV support to avoid implantation of the problematic long-term biventricular assist devices. SN - 1538-943X UR - https://www.unboundmedicine.com/medline/citation/21642843/Successful_use_of_temporary_right_ventricular_support_to_avoid_implantation_of_biventricular_long_term_assist_device:_a_transcutaneous_approach_ L2 - https://doi.org/10.1097/MAT.0b013e31821f2130 DB - PRIME DP - Unbound Medicine ER -