Temporary Mechanical Circulatory Support for Acute Right Ventricular Failure

Abstract

Purpose Mechanical circulatory support (MCS) may be required for patients with acute right ventricular failure (ARVF) refractory to conventional therapy. The right ventricle (RV) exhibits a greater capacity for rapid recovery compared to the left ventricle, making devices designed specifically for temporary RV support attractive. We report our experience with the Impella Right Direct (RD) and Right Peripheral (RP) microaxial pumps. Methods and Materials We conducted a retrospective cohort study examining the clinical outcomes of patients requiring MCS for ARVF at 2 institutions over a 6-year period. Results Twenty-three patients (55±13 years old, 70% male) required MCS for ARVF, developing post-cardiotomy in 6 (26%), post-left ventricular assist device in 3 (13%), post-heart transplant in 3 (13%), and as a consequence of myocardial infarction in 8 (35%) and myocarditis in 3 (13%) patients. Prior to implantation, 23 (100%) patients required inotropic support, 4 (17%) suffered a cardiac arrest, 9 (39%) required an intra-aortic balloon pump, and 8 (35%) required inhaled nitric oxide. MCS resulted in a significant improvement in cardiac index (pre-MCS: 2.1±0.6 vs. post-MCS: 2.7±0.5 L/min/m2, p=0.045). MCS was provided by the Impella RP in 3 (13%), Impella RD in 15 (65%), and Biomedicus centrifugal pump in 5 (22%). Six (26%) patients died with the device after 5 [IQR 2-7] days of support, 15 (65%) patients recovered sufficient RV function to facilitate device explanation after 7 [IQR 5-9] days of support, and 2 (9%) patients were transitioned to a long-term device. At 1-year follow-up, 52% of patients were alive and the majority exhibited normal functional capacity and RV function. Conclusions Many patients with ARVF rapidly recover sufficient RV function to facilitate device explantation, highlighting an expanding role for minimally invasive RV assist devices optimized for the treatment of recoverable ARVF. The Impella RP (investigational) provides sufficient hemodynamic support and may offer significant advantages over previous devices.