B. Badu1, M. T. Cain1, Z. R. Laste2, L. Durham1, L. Joyce1, D. Ishizawar3, M. Saltzberg3, N. Gaglianello3, A. Mohammed3, D. L. Joyce1 1Medical College Of Wisconsin,Cardiothoracic Surgery,Milwaukee, WI, USA 2Medical College Of Wisconsin,Radiology,Milwaukee, WI, USA 3Medical College Of Wisconsin,Cardiology/Medicine,Milwaukee, WI, USA
Introduction:
Severe right ventricular (RV) failure requiring right ventricular assist device (RVAD) implantation is encountered following severe acute pulmonary hypertension secondary to acute respiratory distress syndrome or pulmonary embolism, and left ventricular assist device (LVAD) implantation. Mortality at 1-year reach 30% and 40%, respectively1. Percutaneous RVAD technology is emerging, but understudied2.
Methods:
Patient charts were retrospectively reviewed for demographic and perioperative cardiac hemodynamic data, etiology of RV failure, and comorbid conditions in all patients receiving percutaneous RVAD support at our academic institution between April 2017 and August 2018. The primary outcomes we assessed were in-hospital mortality, duration of RVAD support, ICU length of stay, and device related complications such as bleeding, stroke, and the need for surgical revision.
Results:
Percutaneous RVAD was used in 23 patients (16 men, 70%); median age, 58 [19 to 66] years). Indications for implantation included RV failure post LVAD implantation (n=11, 48%), acute respiratory distress syndrome (n=5, 22%), myocardial infarction (n=5, 22%), post cardiac transplant (n=1, 4%), and viral cardiomyopathy (n=1, 4%). Median duration of support was 14 (3 to 23) days and 18 (78%) patients were successfully weaned or underwent cardiac transplantation. Overall in-hospital mortality was 34.8%. In-hospital mortality among patients with RV failure after permanent LVAD was 0 % with 1 late death at 150 days. Mortality among patients with primary pulmonary etiology was 40%. There was no mortality with RV failure post-transplant or after viral cardiomyopathy. Severe postoperative bleeding requiring reoperation was noted in 3 (13%) patients. Superior vena cava obstruction occurred in 2 (8%) patients and device migration in 1 (4%) patient. No device-related infection or pulmonary emboli were noted.
Conclusion:
Percutaneous RVAD support appears to be a versatile and effective tool in treating patients with severe RV failure, with particular benefit after LVAD implantation. These findings support the need for additional investigation into the benefits of this device.
References:
1. Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34;1495-504.
2. Ravichandran AK, Baran DA, Stelling K, Cowger JA, Salerno CT. Outcomes with the Tandem Protek Duo dual-lumen percutaneous right ventricular assist device. ASAIO J. 2018;64:570-2.