Single Center Experience with a Percutaneous Right Ventricular Assist Device in the Management of Right Ventricular Failure

Abstract

Purpose Right ventricular assist device (RVAD) support can be beneficial in a variety of clinical scenarios including post cardiotomy RV failure, cardiogenic shock, and severe acute hypoxemic respiratory failure with associated RV dysfunction. Reported mortality after RVAD insertion ranges from 37% to 46%. Percutaneous RVAD support via right internal jugular vein has emerged with the potential for enhanced weaning and ambulation strategies. However, the experience with such an approach remains limited. Methods A comprehensive retrospective review was completed for all patients receiving percutaneous RVAD support via a right internal jugular route at our institution between April 2017 and September 2018. Successful weaning from support, in-hospital mortality, and freedom from device related complications were assessed. Results Percutaneous RVAD support was instituted in 31 patients (22 men, 71%) with a median age of 58 years (19 to 77 years). Indications for implantation were divided into 3 groups. Group 1: Post cardiotomy support (n=18, 58%) including following LVAD insertion, pulmonary thromboendarterectomy, bilateral lung transplant, or cardiac transplantation, Group 2: Cardiogenic shock (n=7, 23%), and Group 3: Primary respiratory failure (n=6, 19 %). There were no failures to wean RVAD in Group 1, compared with 67% failure to wean in Group 2 and 33% in Group 3. Median duration of support in Group 1 was 16 (7-36) days, 5 (1-16) days in Group 2, and 13 (8-18) days in Group 3. All-cause mortality for the entire cohort was 29%. Mortality in Group 1 was 2/18 (11%), Group 2 was 4/7 (57%), and Group 3 was 3/6 (50%). Complications included postoperative bleeding requiring reoperation in 7 (23%) patients, device related superior vena cava obstruction in 3 patients (10%), and device migration in 2 (6%) patients. There were no device-related infections, DVT, valvular damage, or pulmonary emboli observed in this cohort. No patients required transition to implantable long-term RVAD. Conclusion Percutaneous RVAD support appears to be a versatile and effective tool for treating patients with severe RV failure, with best outcomes in the post cardiotomy group. The ability to ambulate these patients while on support and remove the device at the bedside without surgery may permit a more liberal use of this technology with improvements in outcomes in RV failure.