Advertisement

Temporary Right Ventricular Assist Device Support for Acute Right Heart Failure: A Single-Center Experience

Published:October 13, 2022DOI:https://doi.org/10.1016/j.jss.2022.09.009

      Abstract

      Introduction

      Severe right ventricular (RV) failure is associated with significant morbidity and mortality. Although right ventricular assist devices (RVADs) are increasingly used for refractory RV failure, there is limited data on their short- and long-term outcomes. Therefore, we undertook this study to better understand our experience with temporary RVADs.

      Methods

      We conducted a retrospective review of all RVADS performed from 2017 to 2021. Patients supported with surgical RVADs, the Protek Duo device, and the Impella RP device were included. Patients were stratified by the type of RVAD and by etiology of RV failure. Survival was assessed by the Kaplan–Meier method and multivariable Cox proportional hazards regression models.

      Results

      From 2017 to 2021, 42 patients underwent RVAD implantation: 32 with a Protek Duo, 6 with an Impella RP, and 4 with a surgical RVAD. Majority of patients were already supported with an alternate form of mechanical support. Most patients had impaired renal function, decreased hepatic function, and lactic acidosis at the time of cannulation. The median duration of RVAD support was 8.5 [5-19] d. Survival to decannulation was 68.4%, to discharge was 47.4%, and to 1-y was 40.2%. Multivariable analysis identified elevated total bilirubin levels to be associated with 30-d mortality while increased hemoglobin levels were protective. After RVAD cannulation, the median number of pressors and inotropes was lower (P < 0.01) and the lactic acidosis was less (P < 0.01).

      Conclusions

      In conclusion, RVAD support is associated with lower lactate levels, and decreased number of vasoactive medications, but is associated with significant morbidity and mortality.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Anderson M.B.
        • Goldstein J.
        • Milano C.
        • et al.
        Benefits of a novel percutaneous ventricular assist device for right heart failure: the prospective RECOVER RIGHT study of the Impella RP device.
        J Heart Lung Transplant. 2015; 34: 1549-1560
        • Jensen P.B.
        • Kann S.H.
        • Velen K.T.
        • et al.
        Single-center experience with the Impella CP, 5.0, RP in 109 consecutive patients with profound cardiogenic shock.
        Eur Heart J Acute Cardiovasc Care. 2018; 7: 53-61
        • Shekiladze N.
        • Condado J.F.
        • Sandesara P.B.
        • et al.
        A single healthcare experience with Impella RP.
        Catheter Cardiovasc Interv. 2021; 97: E161-E167
        • Goldstein J.A.
        • Kern M.J.
        Percutaneous mechanical support for the failing right heart.
        Cardiol Clin. 2012; 30: 303-310
        • Kapur N.K.
        • Paruchur V.
        • Jagannathan A.
        • et al.
        Mechanical circulatory support for right ventricular failure: the TandemHeart in Right Ventricular Support (THRIVE) Registry.
        JACC Heart Fail. 2013; 1: 127-134
        • Anderson M.
        • Morris D.L.
        • Tang D.
        • et al.
        Outcomes of patients with right ventricular failure requiring short-term hemodynamic support with the Impella RP device.
        J Heart Lung Transplant. 2018; 37: 1448-1458
        • Ravichandran A.K.
        • Baran D.A.
        • Stelling K.
        • et al.
        Outcomes with the tandem Protek Duo dual-lumen percutaneous right ventricular assist device.
        ASAIO J. 2018; 64: 570-572
        • Salna M.
        • Garan A.R.
        • Kirtane A.J.
        • et al.
        Novel percutaneous dual-lumen cannula-based right ventricular assist device provides effective support for refractory right ventricular failure after left ventricular assist device implantation.
        Interact Cardiovasc Thorac Surg. 2020; 30: 499-506
        • Kremer J.
        • Farag M.
        • Brcic A.
        • et al.
        Temporary right ventricular circulatory support following right ventricular infarction; results of a groin-free approach.
        ESC Heart Fail. 2020; 7: 2853-2861
        • Anderson M.B.
        • Robbins T.
        • Tuluca A.
        • et al.
        An expanded assessment of indications for Impella RP: a large single center RVAD experience.
        J Heart Lung Transplant. 2017; 36: 354
        • Monteagudo-Vela M.
        • Simon A.
        • Panoulas V.
        Initial experience with Impella RP in a quaternary transplant center.
        Artif Organs. 2020; 44: 473-477
        • Proudfoot A.
        • Mulder A.
        • Maragiri S.
        • et al.
        A single center experience of the Impella RP in acute right ventricular failure.
        J Heart Lung Transplant. 2018; 37: 262
        • Food and Drug Administration (FDA)
        Impella RP-RWE eval and reporting post-approval study (PAS).
        (Available at:)
        • Qureshi A.M.
        • Tuner M.E.
        • O’Neill W.
        • et al.
        Percutaneous Impella RP use for refractory right heart failure in adolescents and young adults – a multicenter US experience.
        Catheter Cardiovasc Interv. 2020; 96: 376-381
        • Routh S.
        • Fabrizio C.
        • Sciortino C.M.
        • et al.
        Acute right ventricular failure in a patient with nonischemic cardiogenic shock on left-sided mechanical circulatory support.
        J Cardiovasc Surg. 2021; 36: 3884-3888
        • Bhalla A.
        • Attaran R.
        Mechanical circulatory support to treat pulmonary embolism: venoarterial extracorporeal membrane oxygenation and right ventricular assist devices.
        Tex Heart Inst J. 2020; 47: 202-206
        • Carrozzini M.
        • Merlanti B.
        • Olivieri G.M.
        • et al.
        Percutaneous RVAD with the Protek Duo for severe right ventricular primary graft dysfunction after heart transplant.
        J Heart Lung Transplant. 2021; 40: 580-583
        • Randhawa V.K.
        • Hoffman K.
        • Bock A.
        • et al.
        Impella RP as a bridge to cardiac transplant for refractory late right ventricular failure in setting of left ventricular assist device.
        ESC Heart Fail. 2020; 7: 1972-1975
        • Aggarwal V.
        • Einhorn B.N.
        • Cohen H.
        Current status of percutaneous right ventricular assist devices: first-in-man use of a novel dual lumen cannula.
        Catheter Cardiovasc Interv. 2016; 88: 390-396
        • Cain M.T.
        • Smith N.J.
        • Barash M.
        • et al.
        Extracorporeal membrane oxygenation with right ventricular assist device for COVID-19 ARDS.
        J Surg Res. 2021; 264: 81-89