Planned Concomitant Left and Right Ventricular Assist Device Insertion to Avoid Long-term Biventricular Mechanical Support: Bridge to Right Ventricular Recovery

Authors

  • Michael Salna Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
  • Yasuhiro Shudo Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
  • Jeffrey J Teuteberg Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
  • Dipanjan Banerjee Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
  • Richard V. Ha Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
  • Y. Joseph Woo Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
  • William Hiesinger Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA

DOI:

https://doi.org/10.1532/hsf.2035

Abstract

Introduction: The planned use of a temporary right ventricular assist device (RVAD) at the time of left ventricular assist device (LVAD) implantation may prevent the need for a permanent biventricular assist device (BiVAD). Herein we describe our RVAD weaning protocol that was effectively employed in
4 patients to prevent the need for permanent BiVAD.

Methods: Four patients in refractory cardiogenic shock underwent planned RVAD insertion during LVAD implantation due to severely depressed right ventricular function with dilation preoperatively. A standardized RVAD weaning protocol was employed in these 4 patients in preparation for decannulation.

Results: Temporary RVADs were successfully placed in all 4 patients at the time of LVAD implantation. All patients survived to RVAD decannulation and discharge and were alive at the time of most recent follow-up (range, 528-742 days post–RVAD decannulation).

Conclusion: Planned implantation of a temporary RVAD in high risk patients may avoid the need for biventricular mechanical support in the future.

References

Anderson B, Goldstein J, Milano C, et al. 2015. 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 34:1549-60.

Kang G, Ha R, Banerjee D. 2016. Pulmonary artery pulsatility index predicts right ventricular failure after left ventricular assist device implantation. J Heart Lung Transplant 35:67-73.

Kirklin JK, Naftel DC, Kormos RL, et al. 2013. Fifth INTERMACS annual report: risk factor analysis from more than 6,000 mechanical circulatory support patients. J Heart Lung Transplant 32:141-56.

Levin AP, Jaramillo N, Garan AR, et al. 2016. Outcomes of contemporary mechanical circulatory support device configurations in patients with severe biventricular failure. J Thorac Cardiovasc Surg 151:530-535.e2.

Ravichandran AK, Baran DA, Stelling K, Cowger JA, Salerno CT. 2018. Outcomes with the Tandem Protek Duo dual-lumen percutaneous right ventricular assist device. ASAIO J 64:570-2.

Rose EA, Gelijns AC, Moskowitz AJ, et al. 2001. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 345:1435-43.

Takeda K, Naka Y, Yang JA, et al. 2014. Outcome of unplanned right ventricular assist device support for severe right heart failure after implantable left ventricular assist device insertion. J Heart Lung Transplant 33:141-8.

Yancy CW, Jessup M, Bozkurt B, et al. 2013. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62:e147-239.

Published

2018-10-01

How to Cite

Salna, M., Shudo, Y., Teuteberg, J. J., Banerjee, D., Ha, R. V., Woo, Y. J., & Hiesinger, W. (2018). Planned Concomitant Left and Right Ventricular Assist Device Insertion to Avoid Long-term Biventricular Mechanical Support: Bridge to Right Ventricular Recovery. The Heart Surgery Forum, 21(5), E412-E414. https://doi.org/10.1532/hsf.2035

Issue

Vol. 21 No. 5 (2018)

Section

Articles

Author Disclosure & Copyright Transfer Agreement

In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.

A current form follows:

The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.

However, Publisher grants back to the author(s) the following:

  1. The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
  2. The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
  3. The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
  4. The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
  5. The right to make oral presentations of material from this work.

Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.

I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.

I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).

I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.

Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).