“The Right Stuff”: Using a Caval Stent Valve to Mitigate the Effect of Right Heart Failure in LVAD Patients

Abstract

Purpose Right heart failure following left ventricular assist device implantation is one of the major challenges in patients suffering from advanced heart failure. There is still no ideal right-sided support system available. Here we describe the implantation of a stent valve at the inferior cavoatrial junction to protect liver and kidney during right heart failure. Methods The Medtronic Evolut Pro was delivered via the right jugular vein . Valves were placed in the inferior cavoatrial junction and pressures measured above and below the valve. After initiating biventricular heart failure in a porcine model, a cut down technique was used to access the right IJ. Using fluoroscopy , we then implanted the Evolut Pro valve through the right IJ in 3 animals. Results Pressure measurements using a pigtail catheter were then taken above and below the stent valve to assess the effectiveness of stent valve in reducing pressure in the abdominal inferior vena cava . We successfully implanted a stent-valve using endovascular technique in the inferior cavoatrial junction. Pressures above and below the stent-valve were markedly different as shown during random Pressure measurements (Delta P > 5 mmHG) when the upper body part of the animal was elevated. Conclusion Implantation of a stent-valve may prevent or slow the progression of multi-system organ failure that often accompanies right heart failure after LVAD implantation. This study demonstrates the feasibility of this technique though additional study is warranted.