Development of a Double-Lumen Cannula for a Percutaneous RVAD

Abstract

The objectives were to design/fabricate a double lumen cannula (DLC) for a percutaneous RVAD (pRVAD), and to test the feasibility/performance of this pRVAD system. A 27 Fr DLC prototype was made and tested in 6 adult sheep. The pRVAD DLC was inserted into the right jugular vein, advanced through the superior vena cava (SVC)-right atrium (RA)-right ventricle (RV), and ended in the pulmonary artery (PA). A CentriMag pump and optional gas exchanger were connected to the DLC. Blood was withdrawn from RA, pumped through gas exchanger, and perfused PA. Maximal pumping flow was maintained for 2 hours. The pRVAD DLC was successfully deployed in all 6 sheep. In first 3 sheep, maximal average pumping flow was below 3 l/min because the DLC was advanced too far with drainage opening against RA side wall. In last 3 sheep with well positioned DLC, average maximal flow was above 3.5 l/min. The gas exchanger provided up to 230 ml/min CO2 removal and 174 ml/min O2 transfer. Our DLC-based pRVAD system is feasible for percutaneous right heart and respiratory assistance through a single cannulation. The pRVAD DLC can easily be placed prophylactically during LVAD implantation and removed as needed without additional open chest procedures.

The ProtekDuo in ECMO configuration for ARDS secondary to COVID-19: A systematic review

“…The group of Zwischenberger first described the placement of a single-site, percutaneous, double-lumen cannula for RVAD in an ovine model in 2015. 5 Over the following years, numerous authors have reported cases in which the ProtekDuo has been utilized in multiple configurations including its original configuration as RVAD, RVAD with oxygenator for ECMO (V-P ECMO/OxyRVAD), left ventricular assist device (LVAD), biventricular assist device (BiVAD) or ECPELLA 2.0 when either combined with a durable LVAD or any of the multiple available Impella ® devices. It had also been used as double-lumen drainage cannula for cardiopulmonary bypass (CPB), and in other ECMO configurations, such as veno-pulmonary (V-P), venovenous-pulmonary (VV-P), and in veno-venopulmonary (V-VP) ECMO.…”

“…The group of Zwischenberger first described the placement of a single-site, percutaneous, double-lumen cannula for RVAD in an ovine model in 2015. 5 Over the The ProtekDuo was placed in a late stage after V-V ECMO when either right heart failure or oxygenation problems occurred.…”

Adaptive ECMO Therapeutics: The Integral Role of the ProtekDuo® Cannula

“…Wang and colleagues first described the use of a single-site, dual-lumen cannula for a percutaneous right ventricular assist device (RVAD) with an optional membrane lung (ML) in an ovine model in 2015 [1]. The following year, Aggarwal et al described a patient with combined cardiogenic shock due to right ventricular failure (RVF) and hypoxic respiratory failure, treated with the ProtekDuo® cannula as part of an ECMO system that provided both right ventricle (RV) and respiratory support [2].…”

Ventricular interdependence in critically ill patients: from physiology to bedside

“…Peripheral veno-arterial ECMO, by unloading the RV and then, inverting the trans-septal gradient, has been described efficient in situation of high risk pulmonary embolism ( Assouline et al, 2022 ), while same result was suggested using VV ECMO in ARDS ( Miranda et al, 2015 ). Temporary RV assist devices have even been developed, such as double-lumen cannula placed percutaneously ( Wang et al, 2015 ) and advanced through the superior vena cava, the right atrium, the right ventricle and ending in the pulmonary artery. Studies to evaluate these devices are however still needed, but it could be useful in case of severe acute cor pulmonale with high deleterious ventricular interdependence by helping the right ventricle to struggle against an acute rise of pulmonary vascular resistance, situations encountered, for example, in ARDS or in acute chest syndrome due to sickle cell disease.…”