Percutaneous right ventricular support: Initial experience from the tandemheart experiences and methods (THEME) registry
Bermudez C, Chetcuti SJ, Coletti AT, O'Neill BP, Alaswad K, Ragosta M, Joyce DL, Ramzy D. Percutaneous right ventricular support: Initial experience from the tandemheart experiences and methods (THEME) registry. ASAIO Journal. 2018;64:71.
Study: Right ventricular (RV) failure after open cardiac operations increases morbidity, and mortality can be as high as 50%. Until recently, mechanical RV support required open chest implantation and removal. We present theinitial outcomes of percutaneous RV support using theTandemHeart pump (THP) and PROTEK Duo cannula (PDC). The duallumen PDC allows both drainage and reinfusion of blood and can provide RV support when placed with theinflow in the right atrium and outflow in the pulmonary artery. With the THP, the PDC can provide up to 5 L/min continuous flow. Methods: We identified patients supported for RV failure after cardiac surgery in theTandemHeart Experiences and Methods (THEME) Registry. Results: Twenty patients received support with a THP and PDC as a percutaneous right ventricular-assist device (pRVAD). Their mean age was 53 ± 17 years; 14 were male. RV support was needed after left ventricularassist device (LVAD) implantation in 80% (81.3% early; 18.8% late), postcardiotomy shock (PCS) in 10%, and post-heart-transplant failure (PHTF) in 10%. The PDC was successfully placed all patients, and there were no major complications associated with pRVAD implementation including no cardiac ruptures or severe ventricular arrhythmias. Mean support was 10.3 ± 6.7 days with a mean flow of 3.9 ± 0.8 L/min. Complications included bleeding (25%), infections (10%), and hemolysis (5%) There was 1 cardiac arrhythmia 2 days post-insertion requiring amiodarone and cardioversion. Cannula thrombosis occurred after 26 days of support in 1 patient. The need for inotropes and vasoconstrictors rapidly decreased with pRVAD support (Fig. 1) The pRVAD was successfully removed from 17 patients; 30-day survival was 85% (50% PCS, 87.5% post-LVAD and 100% PHTF). Using the THP with a PDC as a pRVAD is a safe and effective way to manage RV failure after cardiac operations and is an alternative to surgically implanted devices.