Superior Vena Cava Syndrome from Percutaneous Right Ventricular Assist Device Use in Right Ventricular Failure

Abstract

Percutaneous right ventricular assist device (RVAD) support with right internal jugular (IJ) vein access has emerged as a viable solution for treating refractory RV failure. Recent reports have shown that RVAD support with this approach 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, as well as decreased mortality compared to surgically implanted RVADs. However, the safety profile of such devices has not been characterized. A comprehensive retrospective review was completed for all patients receiving percutaneous RVAD support via a right internal jugular route with either 28 or 31F cannula at our institution between April 2017 and December 2018. Preoperative patient demographics, intraoperative, and postoperative outcomes, with specific focus on device related complications. Fourty patients (27 men, 67.5%) with mean age of 52 years ± 15.6 and refractory RV failure were managed with a percutaneous RVAD inserted through the right IJ. Of these 40 patients, 3 (7.5%) patients demonstrated device related superior vena cava (SVC) syndrome resulting from obstruction of the SVC with the RVAD cannula. One patient managed by head of bed elevation and early removal of the device (I believe). Two were treated by connecting a "venting" tubing to the side port on the introducer sheath and placing into the ECMO circuit to for decompression. Symptoms resolved in all 3 patients and no deaths resulted from SVC syndrome. SVC syndrome related to percutaneous RVAD placement is an important, but previously undescribed postoperative complication of RVAD use. Early identification allows safe management of this complication, which does not detract from the safety of percutaneous RVAD support.