Contemporary Experience with Percutaneous and Surgical Right Ventricular Assist Devices

Abstract

Purpose Significant uncertainty exists regarding the deployment of the recently developed percutaneous right ventricular assist device (pRVAD) in the context of high mortality from right ventricular failure. We compare our initial institutional experience with pRVAD with our contemporary experience with surgical right ventricular assist device (sRVAD). Methods and Materials Percutaneous RVAD was accomplished in the Hybrid operating room. The right internal jugular vein was accessed percutaneously and a 17F Medtronic cannula was passed over a guidewire into the main pulmonary artery. Position was verified using TEE. A long 21F or 25F multistage venous cannula was used for inflow from the femoral vein. sRVAD implantation was performed using standard Thoratec cannulae from the right atrium to the pulmonary artery. An oxygenator was utilized in-line for 2/3 pRVAD patients and 7/17 sRVAD patients. Results Between January 2009 and September 2012, 17 patients underwent placement of sRVAD. During that contemporaneous period, 3 patients underwent pRVAD placement. Indications for pRVAD were RV infarct, RV failure s/p LVAD, and fulminant viral myocarditis. All 3 patients with pRVAD implant survived, 11/17 patients with sRVAD survived. All 3 pRVADs were removed at the bedside without complication. Mean duration of pRVAD support was 4 days. No patient with pRVAD required subsequent re-operation, whereas all sRVAD survivors required at least one further sternotomy. Conclusions pRVAD ease of insertion and removal may lower resistance to RVAD deployment. Support comparable to sRVAD may allow pRVAD use for both early deployment, critical for survival, and as the final procedure after anticipated RV recovery. Also, pRVAD remains flexible to support an in-line oxygenator for the impaired lungs.