Novel Percutaneous Dual Lumen Cannula Right Ventricular Assist Device Provides Effective Support for Patients after Left Ventricular Assist Device Implantation

• Published in: The Journal of heart and lung transplantation Vol. 38; no. 4; p. S231
• Main Authors: Salna, M., Garan, A.R., Kirtane, A., Karmpaliotis, D., Green, P., Vahl, T., Takayama, H., Sanchez, J., Kurlansky, P., Yuzefpolskaya, M., Colombo, P.C., Naka, Y., Takeda, K.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2019
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2019.01.569

The indications, efficacy, and safety profile of temporary, percutaneous dual lumen cannula-based right ventricular assist devices (RVAD) [TandemLife ProtekDuo] after left ventricular assist device (LVAD) placement have not been well characterized. We describe our experience with the largest series of patients reported to date. We conducted a retrospective review of 24 patients who received ProtekDuo RVAD support from January 2016 through July 2018. Outcomes of interest included indications for support, procedural success, complications, and clinical outcomes. Patients were 79% male (n=19) with a median age of 66 (IQR 58-72). ProtekDuo RVAD support was initiated a median of 1 day (IQR 0-2) after LVAD implantation. Indications for RVAD placement included pure RV failure (n=14, 58%), vasoplegia (n=2, 8%), or mixed syndrome (n=8, 33%). Procedural success was 100% without any complications. Initial median flow was 4.1 L/min (IQR 3.8-4.5) with a median indexed flow of 2.0 L/min/m2 (IQR 1.8-2.3). During a median support of 11 days (IQR 7-14), major complications included cannula thrombosis (n=1), cannula migration into the RV requiring repositioning (n=2), and hemolysis, as defined by progressively rising LDH and plasma free hemoglobin levels (n=4). A total of 18 patients (75%) were weaned from the ProtekDuo RVAD with cannulas removed at the bedside in all patients. Three patients died while on ProtekDuo support and three were converted to central RVAD support. Overall survival to discharge was 78% (n=18/23) with one patient remaining in-hospital. Survival post-discharge was 100% at the time of most recent follow-up, with a median duration of 211 days (IQR 98-523). The ProtekDuo RVAD affords a safe and reliable bridge to right ventricular recovery as a less invasive percutaneous option after LVAD placement.