Current status of percutaneous right ventricular assist devices: First‐in‐man use of a novel dual lumen cannula

Abstract

Ventricular assist devices have become an accepted therapeutic solution for patients with severe left ventricular dysfunction when pharmacology fails to maintain sufficient cardiac output. Despite various technologies that have allowed left ventricular assist devices to become more reliable and versatile in the past decade, comparatively little attention has been applied to right heart assistance which is still in the early stage of its development. The extracorporeal devices developed thus far have been associated with mobility issues and complications common to ventricular assist devices in general, such as infection, bleeding, and thromboembolism. Designed to obviate the problems previously experienced by other right ventricle (RV)-focused devices, the Protek Duo (CardiacAssist, Pittsburgh, PA) is a novel, fully percutaneous, dual lumen cannula for RV support used in conjunction with the paracorporeal TandemHeart(®) (CardiacAssist, Pittsburgh, PA) pump. We describe our initial experience with the Protek Duo cannula in two different clinical scenarios. In addition, we summarize the current percutaneous mechanical support technology for RV assistance and propose modification of current technology to facilitate its application. © 2016 Wiley Periodicals, Inc.

Mechanical Circulatory Support Devices for Acute Right Ventricular Failure

“…Use of the right internal jugular led to development of the Protek Duo dual-lumen cannula, which contains 2 lumens within one 29F or 31F cannula (Figure 2). 71,72 One lumen serves as an inflow cannula ADHF indicates acute decompensated heart failure; AMI, acute myocardial infarction; CABG, coronary artery bypass graft; CI, cardiac index; HF, heart failure; IWMI, inferior wall myocardial infarction; LVAD, left ventricular assist device; MAP, mean arterial pressure; OHT, orthotopic heart transplantation; PA, pulmonary artery; PCCS, postcardiotomy cardiogenic shock; RA, right atrial; RV, right ventricular; TH-RVAD, TandemHeart right ventricular assist device; and VA-ECMO, venoarterial extracorporeal membrane oxygenation.…”

“…81 Several case reports have recently described use of the Protek Duo cannula for RV failure in the setting of LVAD implantation and cardiogenic shock resulting from decompensated severe pulmonary hypertension. 71,72 In 2011, a single-center experience reported improvements in mean arterial pressure, RA pressure, cardiac index, RV stroke work, and mixed venous oxygen saturation in 9 patients within 24 hours of TH-RVAD implantation for various causes 82 ( Table 3). The in-hospital mortality rate was 44% and highest among patients with delayed TH-RVAD placement.…”

Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: Techniques, limitations, and special considerations

“…The Protek Duo is also inserted into the right IJ vein but, in contrast to the Avalon Elite ® , the distal tip of this cannula is placed into the main pulmonary artery. [ 36 ] Thus, the Protek Duo may decompress the RV in addition to providing gas exchange. At present, this cannula is new and infrequently used and, as such, will not be discussed further in this review.…”

Percutaneous double lumen cannula for right ventricle assist device system: A computational fluid dynamics study

“…Most recently, the Protek Duo-TandemHeart system has been used for RVAD. [36]. However, this DLC was not designed for RVAD, and was only approved by the FDA for VV ECMO.…”