Temporary Right Ventricular Assist Device Support with a 29-French Protek Duo Cannula to CentriMag Pump in a 12-Year-Old After Left Ventricular Assist Device Placement

Abstract

<h3>Introduction</h3> Right ventricular failure (RVF) after left ventricular assist device (LVAD) placement occurs in approximately 20% of patients. The Protek Duo system by TandemLife can provide access for temporary RVAD support in adults. Here we present the first published case of Protek Duo to temporary CentriMag RVAD support in a pediatric patient with RVF after LVAD placement. <h3>Case Report</h3> A 12-year-old male with obesity (BSA 2.31, BMI 36) presented with severe left ventricular (LV) dilation and dysfunction and moderate RV dysfunction. He had Intermacs profile 2 symptoms, and underwent HeartMate 3 (HM3) LVAD placement on hospital day (HD) 8. Genetic testing identified a pathogenic TNNT2 mutation. He initially did well but on HD 13, LVAD flow and perfusion worsened. At cardiac catheterization on HD 15, a transesophageal echocardiogram identified a posterior pericardial thrombus and large effusion requiring needle decompression. Severe RV dysfunction persisted, so a 29Fr Protek Duo cannula was placed in the right internal jugular vein, which measured 10 × 11mm, connected to CentriMag pump for right ventricular assist device (RVAD) support. Placement was complicated by thrombus formation on the outflow tip, which was displaced via Fogarty balloon application technique. At the time ACT was 186 although ACT 300-400 is recommended. Once thrombus resolved, CentriMag flow was 4 L/min and HM3 flow was 4.5-5 L/min. He underwent chest washout on HD 17 and was extubated on HD 18. While supported on RVAD, he continued rehabilitation with the cannula secured to his scalp with Coban, progressing to 250 ft ambulation in one session. On HD 25, he had mild RV dysfunction and preserved end-organ function, so RVAD flow was weaned daily over 11 days to 1800 RPM. RVAD support was removed without event on HD 36, and he was discharged on HD 63. He is over 180 days post-HM3 implantation with moderately decreased biventricular function. <h3>Summary</h3> This is the first described use of Protek Duo 29Fr cannula to CentriMag RVAD for RVF in a pediatric patient after LVAD placement. In the future, we will closely follow ACT guidelines. Ambulation continued once stable on RVAD, which was weaned off after 21 days of support. Protek Duo cannula to temporary RVAD for RVF has been demonstrated in adults, and here, we were able to support a pediatric patient with RVF after LVAD.