Technique of Implantation and Experience with Temporary Mechanical Cardiac Support in Right Ventricular Failure

Česká verzia

Authors: I. Netuka; J. Malý; O. Szárszoi; H. Říha ¹; D. Turek; M. Urban; I. Skalský; T. Kotulák ¹; Z. Dorazilová ²; J. Pirk
Authors place of work: Klinika kardiovaskulární chirurgie, Institut klinické a experimentální medicíny, Praha a Centrum výzkumu chorob srdce a cév 4, Praha, Česká republika ; Klinika anesteziologie a resuscitace, Institut klinické a experimentální medicíny, Praha a Centrum výzkumu chorob srdce a cév 4, Praha, Česká republika ¹; Klinika kardiologie, Institut klinické a experimentální medicíny, Praha a Centrum výzkumu chorob srdce a cév 4, Praha, Česká republika ²
Published in the journal: Rozhl. Chir., 2011, roč. 90, č. 2, s. 88-94.
Category: Monothematic special - Original

Summary

Aim:
Severe right heart failure remains unfrequent but fatal complication of cardiac surgical procedures. Implantation of temporary right ventricular assist device may be life-saving procedure in various situations of right heart failure as: heart transplantation, LVAD therapy and post-cardiotomy failure. The aim of the study is an introduction of the implantation technique and retrospective review of current experience with the method.

Material and Methods:
Since January 2007 isolated right ventricular assist device Levitronix CentriMag has been implanted in 16 patients. Patients were divided into 3 groups: post transplantation (post-Tx), post LVAD implantation (post-LVAD) and other cardiac procedures (OCP). Success rate of weaning from RVAD, 30-days mortality and major complications has been assessed.

Outcomes:
Distribution of implants in groups was: post-Tx 5 pts (31%), post-LVAD 6 pts (38%) and 5 in OCP group (31%). The mean support time was 12 days. Off-pump implantation was achieved in 9 pts. The device was successfully weaned in 13 (81%) patients. 30-days mortality occurred in 1 case only.

Conclusion:
Presented outcomes are encouraging for broader acceptance of the therapy. Excellent success rate has been reached in post-Tx and post-LVAD. This study emphasises decesive role of proactive approach in early indication of RVAD implantation for achieving satisfactory results.

Key words:
right heart failure – ventricular assist device – heart transplantation – right ventricle – implantation

Zdroje

1. Chen, J. M., Levin, H. R., Rose, E. A., et al. Experience with right ventricular assist devices for perioperative right-sided circulatory failure. Ann. Thorac. Surg., 1996; 61: 305–310.

2. Moazami, N., Pasque, M. K., Moon, M. R., et al. Mechanical support for isolated right ventricular failure in patiens after cardiotomy. J. Heart. Lung. Transplant., 2004; 23: 1371–1375.

3. Farrar, D. J., Hill, J. D., Pennington, D. G., et al. Preoperative and postoperative comparison of patients with univentricular and biventricular support with the Thoratec ventricular assist device as a bridge to cardiac transplantation. J. Thorac. Cardiovasc. Surg., 1997; 113: 202–209.

4. Deng, M. C., Edwards, L. B., Hertz, M. I., et al. Mechanical circulatory support device database of the International Society for Heart and Lung Transplantation: Third annual report-2005. J. Heart. Lung. Transplant., 2005; 24: 1182–1187.

5. Kavarana, M. N., Pessin-Minsley, M. S., Urtecho, J., et al. Right ventricular dysfunction and organ failure in left ventricular assist device recipients: a continuing problem. Ann. Thorac. Surg., 2002; 73: 745–750.

6. Netuka, I., Maly, J., Szarszoi, O. Mechanické srdeční podpory v terapii terminálního srdečního selhání. Cor. Vasa., 2008; 50: 207–214.

7. Netuka, I., Szarszoi, O., Maly, J. Comprehensive Management of Severe Intestinal Bleeding in a Patient Supported for 94 Days by the Biventricular Levitronix CentriMag System. Heart. Surg. Forum, 13 (6), 2010, v tisku.

8. Kirklin, J. K., Naftel, D. C., Kirklin, J. W., et al. Pulmonary vascular resistance and the risk of heart transplantation. J. Heart. Transplant., 1988; 7: 331–336.

9. Jeevanandam, V., Furukawa, S., Prendergast, T. W., et al. Standard criteria for an acceptable donor heart are restricting heart transplantation. Ann. Thorac. Surg., 1996; 62: 1268–1275.

10. Bhama, J. K., Kormos, R. L., Toyoda, Y., et al. Clinical experience using the Levitronix CentriMag system for temporary right ventricular mechanical circulatory support. J. Heart. Lung. Transplant., 2009; 28: 971–976.

11. John R., Lee S., Eckman P. Right Ventricular Failure-A Continuing Problem in Patients with Left Ventricular Assist Device Support. J. Cardiovasc. Transl. Res., 2010.

12. Dang, N. C., Topkara, V. K., Mercando, M., et al. Right heart failure after left ventricular assist device implantation in patiens with chronic congestive heart failure. J. Heart. Lung. Transplant., 2006; 25: 1–6.

13. Shuhaiber, J. H., Jenkins, D., Berman, M., et al. The Papworth experience with the Levitronix CentriMag ventricular assist device. J. Heart. Lung. Transplant., 2008; 27: 158–164.

14. Fitzpatrick, J. R., Frederick, J. R., Hiesinger, W., et al. Early planned institution of biventricular mechanical circulatory support results in improved outcomes compared with delayed conversion of a left ventricular assist device to a biventricular assist device. J. Thorac. Cardiovasc. Surg., 2009; 137: 971–977.

15. Kormos, R. L., Gasior, T. A., Kawai, A., et al. Transplant candidate’s clinical status rather than right ventricular function defines need for univentricular versus biventricular support. J. Thorac. Cardiovasc. Surg., 1996; 111: 773–783.

16. Matthews, J. C., Koelling, T. M., Pagani, F. D., et al. The right ventricular failure risk score a preoperative tool for assessing the risk of right ventricular silure in left ventricular assist device candidates. J. Am. Coll. Cardiol., 2008; 51: 2163–2172.

17. DeRobertis, F., Rogers, P., Amrani, M., et al. Bridge to decision using the Levitronix CentriMag short-term ventricular assist device. J. Heart. Lung. Transplant., 2008; 27: 474–478.

18. Noon, G. P., Lafuente, J. A., Irwin, S. Acute and temporary ventricular support with BioMedicus centrifugal pump. Ann. Thorac. Surg., 1999; 68: 650–654.

19. McCoy, J. V., Hollenberg, S. M., Dellinger, R. P., et al. Continuous cardiac index monitoring: A prospective observational study of agrement between a pulmonary artery catheter and a calibrated minimaxy invasive techniqe. Resuscitation, 2009; 80: 893–897.

20. Loforte, A., Montalto, A., Monica, P. L. D., et al. Simultaneous temporary CentriMag right ventricular assist device placement in HeartMate II left ventricular assist system recipients at higt risk of right ventricular failure. Interact. Cardiovasc. Thorac. Surg., 2010; 10: 847–850.

21. Velik-Salchner, C., Hoermann, Ch., Hoefer, D., et al. Thromboembolic complications during weaning from right ventricular assist device support. Anesth. Analg., 2009; 109: 354–357.