Salna Michael, Garan A Reshad, Kirtane Ajay J, Karmpaliotis Dimitrios, Green Phil, Takayama Hiroo, Sanchez Joseph, Kurlansky Paul, Yuzefpolskaya Melana, Colombo Paolo C, Naka Yoshifumi, Takeda Koji
Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA.
Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University Medical School, Boston, MA, USA.
Interact Cardiovasc Thorac Surg. 2020 Apr 1;30(4):499-506. doi: 10.1093/icvts/ivz322.
Right heart failure after left ventricular assist device (LVAD) implantation is associated with significant morbidity and mortality. A new generation of percutaneous right ventricular assist devices (RVADs) may mitigate the need for invasive surgical RVAD implantation. The purpose of this study was to evaluate the safety and efficacy of the Protek Duo (TandemLife, Pittsburgh, PA, USA) RVAD in patients who developed severe acute right heart failure in the intensive care unit after LVAD implantation.
This was a retrospective cohort study of 27 patients who received a Protek Duo after LVAD implantation from January 2016 to March 2019 at our centre. The primary outcome of interest was survival to hospital discharge. Secondary outcomes included procedural success, device-related complications and conversion to a surgical RVAD.
The median age of patients was 63 years (interquartile range 58-71), 78% were men and 78% were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 or 2. Patients were on a median of 2 inotropes and 2 pressors prior to Protek Duo insertion. The device successfully implanted on the first attempt in all patients a median of 1 day (interquartile range 1-2) after LVAD implantation and the median duration of support was 11 days (interquartile range 7-16). Device weaning occurred in 86% of patients, with 15% in-hospital mortality. Major complications related to the device included new moderate-to-severe tricuspid regurgitation (36%), haemolysis (14%) and cannula migration (7%). Three patients (11%) required conversion to surgical RVAD. Overall survival to 1 year was 81%.
The use of the Protek Duo as a percutaneous RVAD is a safe and feasible treatment for patients who develop acute right heart failure after LVAD implantation.
左心室辅助装置（LVAD）植入术后发生的右心衰竭与显著的发病率和死亡率相关。新一代经皮右心室辅助装置（RVAD）可能会减少侵入性手术植入RVAD的需求。本研究的目的是评估在美国宾夕法尼亚州匹兹堡市TandemLife公司生产的Protek Duo RVAD对LVAD植入术后在重症监护病房发生严重急性右心衰竭患者的安全性和有效性。
这是一项回顾性队列研究，研究对象为2016年1月至2019年3月在我们中心接受LVAD植入术后使用Protek Duo的27例患者。感兴趣的主要结局是出院存活情况。次要结局包括手术成功、与装置相关的并发症以及转为外科RVAD。
患者的中位年龄为63岁（四分位间距58 - 71岁），78%为男性，78%为机械辅助循环支持机构间注册（INTERMACS）1或2级。在插入Protek Duo之前，患者使用血管活性药物的中位数为2种正性肌力药物和2种升压药。该装置在所有患者中首次尝试均成功植入，中位时间为LVAD植入术后1天（四分位间距1 - 2天），中位支持时间为11天（四分位间距7 - 16天）。86%的患者成功撤机，住院死亡率为15%。与该装置相关的主要并发症包括新出现的中度至重度三尖瓣反流（36%）、溶血（14%）和插管移位（7%）。3例患者（11%）需要转为外科RVAD。1年总生存率为81%。
对于LVAD植入术后发生急性右心衰竭的患者，使用Protek Duo经皮RVAD是一种安全可行的治疗方法。
