The Protek-Duo Cannula for Temporary Percutaneous Right Ventricular Support: An Early Single-Centre Experience

Abstract

<h3>Purpose</h3> The Protek-Duo is a novel dual lumen cannula, designed for temporary percutaneous right ventricular support. We report our early experience with the use of this device in different clinical scenarios. <h3>Methods</h3> We reviewed all cases of Protek-Duo use at our Institution. One patient was implanted in the operating room by trans-oesophageal echocardiography (TOE) guidance and direct confirmation of the right position through the opened chest. In all the other cases, the device was positioned in the hybrid room under fluoroscopy and TOE monitoring. The Levitronix centrifugal pump was connected to the Protek-Duo to run the para-corporeal right ventricular assist device (RVAD) in each case. <h3>Results</h3> We applied the Protek-Duo cannula in 10 patients. Six were severe right ventricle primary graft dysfunctions (PGD-RV) after heart transplant (HTx). Three were cases of biventricular failure, managed through the Protek-Duo combined to a para-corporeal left ventricular assist device (LVAD). One was a severe acute RV failure after the implantation of a durable LVAD. In all the cases, the 29Fr cannula was used. There were no procedural complications at implant. All the 6 cases of PGD-RV recovered, allowing for the device weaning after 4, 12, 9, 28, 30 and 24 days; one patient died of sepsis late after the device removal. Of the three cases of BiVAD support, two, ineligible to Htx, died after 17 and 15 days of support (due to sepsis and mesenteric ischemia, respectively). The remaining patient, was successfully transplanted after 2 days. The one case of RV failure after durable LVAD implant recovered and was weaned off the support after 25 days. Overall, we recorded 3 thrombotic events (2 in the internal jugular vein and 1 in the RV; all solved by oral anticoagulation), no other device-related complications were observed. <h3>Conclusion</h3> The Protek-Duo cannula proved to be safe and effective as percutaneous RVAD in cases of PGD-RV after HTx, BiVAD support and RV failure after durable LVAD implant.