Miyamoto Takuma, Rahimov Daler, Ahmad Danial, Wood Chelsey T, Leong Ron, Marek-Iannucci Stefanie, Brailovsky Yevgeniy, Rajapreyar Indranee, Rame J Eduardo, Alvarez Rene J, Entwistle John W, Tchantchaleishvili Vakhtang, Massey Howard T
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA.
Artif Organs. 2025 Jan;49(1):156-163. doi: 10.1111/aor.14853. Epub 2024 Sep 30.
We sought to investigate the clinical results of preemptive temporary right ventricular assist device (RVAD) placement with left ventricular assist device (LVAD) implantation for anticipated right ventricular failure.
Patients at risk for right ventricular failure were identified by the heart team. After median sternotomy, Protekduo (LivaNova, London, UK) dual-stage cannula was inserted from the right internal jugular vein under fluoroscopy guidance, and advanced into the pulmonary artery to the bifurcation of the main pulmonary artery. This was then connected to the venous drainage from the right atrium for cardiopulmonary bypass (CPB). After LVAD implantation, we connected the Protekduo cannula to the RVAD with oxygenator, and weaned CPB.
A total of 17 patients have received BiVAD implantation with this technique. The median age of patients was 55 years [Interquartile range (IQR): 51-63.5] and 94% (16/17) patients were male. 63.6% (7/11) of the patients were INTERMACS profile 1 or 2. Preoperatively, the median pulmonary artery pulsatility index was 4.0 [1.5-4.9] and median right ventricular stroke work index was 454.1 g/m/beat/m [436.5-530.2]. Postoperatively, the oxygenators were removed on median postoperative day (POD) 3.5 [3 - 5]. Patients received mechanical ventilation for a median of 4 days [1.5-12] and RVADs were explanted on median POD 8 [7-19] at bedside with local anesthesia. Median ICU stay was 15 days [11.4-24]. Perioperative complications included delayed sternal closure [54.5% (6/11)], re-exploration for bleeding [18% (2/11)], acute kidney injury [36% (4/11)], and heparin induced thrombocytopenia [18% (2/11)]. 30-day mortality was 0% (0/11) and 1 year survival was 85.9%.
Preemptive temporary RVAD implantation strategy for right heart failure post-LVAD showed acceptable clinical outcomes without any 30-day mortality.
我们旨在研究针对预期的右心室衰竭，在植入左心室辅助装置（LVAD）时预先植入临时右心室辅助装置（RVAD）的临床效果。
心脏团队确定有右心室衰竭风险的患者。在正中开胸术后，在透视引导下经右颈内静脉插入Protekduo（英国伦敦LivaNova公司）双级插管，并推进至肺动脉直至主肺动脉分叉处。然后将其连接至右心房的静脉引流以进行体外循环（CPB）。在植入LVAD后，我们将Protekduo插管连接至带有氧合器的RVAD，并撤离CPB。
共有17例患者采用该技术接受了双心室辅助装置（BiVAD）植入。患者的中位年龄为55岁[四分位间距（IQR）：51 - 63.5]，94%（16/17）的患者为男性。63.6%（7/11）的患者为INTERMACS分级1或2级。术前，肺动脉搏动指数的中位数为4.0[1.5 - 4.9]，右心室每搏功指数的中位数为454.1 g/m/次搏动/m[436.5 - 530.2]。术后，氧合器在术后第3.5天[3 - 5]的中位数时间被移除。患者接受机械通气的中位数时间为4天[1.5 - 12]，RVAD在术后第8天[7 - 19]在床边局部麻醉下被取出。重症监护病房（ICU）住院时间的中位数为15天[11.4 - 24]。围手术期并发症包括胸骨延迟闭合[54.5%（6/11）]、再次开胸止血[18%（2/11）]、急性肾损伤[36%（4/11）]以及肝素诱导的血小板减少症[18%（2/11）]。30天死亡率为0%（0/11），1年生存率为85.9%。
LVAD植入后针对右心衰竭的预先植入临时RVAD策略显示出可接受的临床结果，30天无死亡率。
