Results of Temporary Right Heart Assist Device Implantation Following Right Heart Failure

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<h3>Purpose</h3> Temporary circulatory support (TCS) is often needed in right heart failure (RHF). The aim of this study was to conduct a peri- and postoperative analysis of patients with the ProtekDuo® dual lumen canula temporary right ventricular assist device (t-RVAD). <h3>Methods</h3> From 2/2015 to 2/2021, 60 patients (53 male, 88,3%) underwent t-RVAD implantation at our center. In a retrospective single center analysis, we evaluated pre-, intra-, and postoperative data. <h3>Results</h3> Mean age at the time of admission was 56 years ± 13. 87% were male patients. Causes of RHF were: ICMP (32%), DCMP (27%), myocarditis (10%), lung embolism (2%), right ventricular infarction (15%), primary graft failure (3%), secondary RHF after LVAD implantation (8%), Danon disease (2%), not identifiable (2%).Concomitant left ventricular assist device (LVAD) implantations were: HVAD (12%), HM3 (32%), Impella® (12%). T-RVAD implantation secondary to permanent LVAD implantation was performed in 3 patients and 6 patients with ongoing Impella® support were upgraded to temporary BIVAD with an additional t-RVAD. Weaning was performed in 42 patients (70%). After t-RVAD, 3 patients were bridged to durable RVAD and 1 was bridged to heart transplantation. In-hospital mortality was 38%, with 18 patients dying on t-RVAD support. Causes of in-hospital death were low cardiac output (74%), bleeding (13%), hemorrhagic stroke (8,7%) and necrotic pancreatitis (4%). Mean ventilation time was 126 hours ± 128 hours. An oxygenator was added to the circuit in 28%. Mean t-RVAD support time was 15 days ± 10 days with a decrease in central venous pressure from 18 ± 6 vs. 12 ± 5 mmHg, p < 0.01, and an increase in central venous saturation 62 ± 15 vs. 76 ± 7 %, p< 0.01. Overall, 33 patients (55%) could be successfully weaned from t-RVAD and discharged home. Mean hospital stay was 62 days, with 27 days on ICU. Full mobilization was possible in 50% of patients, with all patients being at least mobilized to the edge of the bed. Exchange of the ProtekDuo® was performed in 2 cases for canula thrombosis and dislocation, respectively. All female patients died during their initial hospital stay. <h3>Conclusion</h3> Right heart failure affects a heterogenous patient cohort as demonstrated by our analysis. Groin-free percutaneous implantation of the ProtekDuo® dual lumen cannula allows full mobilization, non-surgical explantation and easy addition of an oxygenator in a clinical setting.