Tarzia Vincenzo, Ponzoni Matteo, Pittarello Demetrio, Gerosa Gino
Cardiac Surgery and Heart Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35128 Padova, Italy.
Anaesthesia and Intensive Care Unit, University of Padova, 35128 Padova, Italy.
J Clin Med. 2022 Nov 29;11(23):7062. doi: 10.3390/jcm11237062.
We propose a patient-tailored strategy that considers the risk for postoperative right heart failure, utilizing the percutaneous ProtekDuo cannula (Livanova, London, UK) in an innovative way to perform cardiopulmonary bypass during LVAD implantation in ECMO patients. Our novel protocol is based on the early intra-operative use of the ProtekDuo cannula, adopting the distal lumen as the pulmonary vent and the proximal lumen as the venous inflow cannula during cardiopulmonary bypass. This configuration is rapidly switched to the standard fashion to provide planned postoperative temporary right ventricular support, in selected patients at high risk of right ventricular failure. From September 2020 to June 2022, six patients were supported with the ProtekDuo cannula during and after an intracorporeal LVAD implantation (five of which were minimally invasive): four HeartMate III (Abbott, U.S.A.) and two HVAD (Medtronic Inc, MN). In all cases, the ProtekDuo cannula was correctly positioned and removed without complications after a median period of 8 days. Non-fatal bleeding (bronchial hemorrhage) occurred in one patient (17%) during biventricular support. Thirty-day mortality was 0%. From this preliminary work, our novel strategy demonstrated to be a feasible solution for planned minimally invasive right ventricular support in ECMO patients scheduled for a durable LVAD implantation.
我们提出了一种针对患者量身定制的策略，该策略考虑了术后右心衰竭的风险，以创新方式利用经皮ProtekDuo插管（Livanova，英国伦敦）在体外膜肺氧合（ECMO）患者植入左心室辅助装置（LVAD）期间进行体外循环。我们的新方案基于术中早期使用ProtekDuo插管，在体外循环期间将远端腔用作肺排气孔，近端腔用作静脉流入插管。对于选定的有右心室衰竭高风险的患者，这种配置会迅速转换为标准方式，以提供计划中的术后临时右心室支持。从2020年9月到2022年6月，6例患者在体内LVAD植入期间及之后使用ProtekDuo插管进行支持（其中5例为微创）：4例HeartMate III（美国雅培公司）和2例HVAD（美敦力公司，明尼苏达州）。在所有病例中，ProtekDuo插管均正确定位，中位8天后无并发症取出。1例患者（17%）在双心室支持期间发生非致命性出血（支气管出血）。30天死亡率为0%。从这项初步工作来看，我们的新策略被证明是为计划进行持久LVAD植入的ECMO患者提供微创右心室支持的可行解决方案。
