Abstract 13116: Improving the Outcome of Patients with Perioperative Right Ventricular Failure Through a Minimal Invasive Right Ventricular Assist Device Implantation Technique
OBJECTIVE: Temporary right ventricular assist device (RVAD) may be required to support patients with perioperative refractory right ventricular failure (RVF). We hypothesize that a minimally invasive RVAD implantation technique, that does not necessitate resternotomy at the time of RVAD removal, may improve the outcome in these patients.
METHODS: We retrospectively reviewed 8 consecutive patients with acute postperative RVF who underwent temporary RVAD implantation between January 2010 and July 2012. A Dacron graft was attached to the main pulmonary artery and passed through a subxiphoid exit, where the RVAD outflow cannula was inserted. The inflow cannula was percutaneously cannulated using Seldinger’s technique in the femoral vein. The sternum was closed primarily in all patients. Levitronix CentriMag system (Levitronix GmbH, Zurich, Switzerland) was used as a RVAD in all patients.
RESULTS: Eight patients (60 ± 18 yo) were supported at our institution using this technique. Five patients had RVF following left ventricular assist device (LVAD) implantation and 3 patients developed postcardiotomy RVF (1 after CABG and 2 following AVR). In 1 patient, an oxygenator was integrated into the RVAD due to impaired pulmonary function. The average duration of RVAD support was 22 ± 27 days (range 6-88 days). In 4 patients the RVAD was successfully removed. Two patients were transplanted 7 and 88 days after LVAD/RVAD implantation and prior to full recovery of RV function. Only 1 patient expired on LVAD/RVAD support. Patient #8 is still ongoing. No mobilization issues were observed. On the day of RVAD explantation, the stretchable outflow graft of the RVAD was carefully pulled under minimal anesthesia, mulltiple ligations were applied and the insertion site was secondarily closed. The RVAD inflow cannula was removed and direct pressure was applied. The in-hospital mortality was merely 12%.
CONCLUSIONS: This report confirms the safety of RVAD implantation using the above described minimal invasive technique for various forms of postoperative RVF. No technical issues were encountered. Early extubation and mobilization, extended support duration and reducing resternotomy risks may explain the better outcome compared with conventional RVAD implantation methods.
- © 2012 by American Heart Association, Inc.