ECPELLA 2.0—Minimally invasive biventricular groin‐free full mechanical circulatory support with Impella 5.0/5.5 pump and ProtekDuo cannula as a bridge‐to‐bridge concept: A first‐in‐man method description

Ruhparwar, Arjang; Oßwald, Anja; Raake, Philip; Kreußer, Michael M.; Großekettler, Leonie; Kretzler, Matthias; Schmack, Bastian

doi:10.1111/jocs.14283

Cited by 28 publications

(34 citation statements)

References 14 publications

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“…Further, major post‐operative complications as defined by INTERMACS, 26 and duration of inotropic support were without a significant difference between the MC and no‐MC groups. Remarkably, there was a trend towards higher incidence of post‐operative RV failure as defined by EUROMACS ( European Registry for Patients with Mechanical Circulatory Support ) 27,28 in the MC group ( P = 0.077), along with a more frequent need for RV support 28,29 and a significantly higher duration of nitric oxygen (NO) ventilation in the MC group ( Table 4 ), pointing to a higher peri‐operative tension on the RV in the MC group compared with the no‐MC group. Functional as well as laboratory and echocardiography parameters did not display differences between the MC and no‐MC groups at one year after LVAD implantation ( Table 5 ).…”

Section: Resultsmentioning

confidence: 99%

MitraClip implantation followed by insertion of a left ventricular assist device in patients with advanced heart failure

et al. 2020

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Aims Mitral valve regurgitation (MR) is common in patients with advanced heart failure (HF). Percutaneous mitral valve repair (PMVR) via MitraClip (MC) has emerged as a feasible treatment strategy for these high-risk patients. However, as HF often further progresses, there is a frequent need for left ventricular assist device (LVAD) implantation in these patients. We aimed to investigate whether prior MC implantation affects the subsequent LVAD implantation and outcome. Methods and results Thirty-seven patients with advanced HF and significant MR who underwent LVAD implantation were retrospectively analysed. Follow-up data were collected at 1 year after LVAD implantation. Primary endpoint was all-cause mortality. Secondary endpoint included peri-operative parameters and clinical development depicted as New York Heart Association (NYHA) class and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level. Seventeen patients initially received a MC device (MC group), resulting in a significant reduction in MR grade. After MC, NYHA class and INTERMACS level further worsened, leading to subsequent LVAD implantation after a median time of 475 days in the MC group. At LVAD implantation, overall characteristics were comparable with those of the patients undergoing LVAD implantation without prior MC placement (no-MC group). Procedural data revealed a higher incidence of right ventricular (RV) failure needing mechanical RV assistance and a longer need for nitric oxide ventilation in the MC group after LVAD implantation. One-year survival was slightly better in the no-MC group compared with the MC group [41% (n = 7/17) vs. 65% (n = 13/ 20); P = 0.15], albeit event-free survival was comparable between both groups, MC and no-MC. Conclusions LVAD implantation after MC is feasible and safe. However, in patients with advanced HF and severe MR, PMVR may only delay a needed LVAD implantation and thereby lead to poorer peri-operative RV function and impaired outcome. Arguably, these patients might benefit from the timely management of advanced HF by the means of early LVAD implantation or heart transplantation.

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Section: Resultsmentioning

confidence: 99%

MitraClip implantation followed by insertion of a left ventricular assist device in patients with advanced heart failure

et al. 2020

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“…The TPD is a dual-lumen omnidirectional cannula that is inserted into the main pulmonary artery via the right IJV 6 . It was originally designed as a veno-venous (V-V) ECMO cannula.…”

Section: Discussionmentioning

confidence: 99%

“…It was originally designed as a veno-venous (V-V) ECMO cannula. This is achieved through an inflow cannula in the right atrium and the outflow cannula in the pulmonary artery 6 . The in-line oxygenator allows the circuit to assume complete and centralized oxygenation support 8 .…”

Section: Discussionmentioning

confidence: 99%

Acquired tracheomalacia due to aortic aneurysm managed with venopulmonary extracorporeal membrane oxygenation for perioperative support

Carlson

Smith

Joyce

et al. 2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…We recently published our results of two cases with an interventional/minimally invasive LV support through Impella® 5.0 or 5.5 and RV support through the ProtekDuo® cannula. This approach provides full biventricular support and LV unloading, with reducing surgical trauma and inflammatory response and allows for a subsequent weaning from left‐side or right‐side support 24 …”

Section: Discussionmentioning

confidence: 99%

Temporary right ventricular circulatory support following right ventricular infarction: results of a groin‐free approach

et al. 2020

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Aims Acute right heart failure (RHF) is a severe complication of right ventricular infarction. The management of acute RHF poses a number of challenges, such as providing haemodynamic support. Temporary circulatory support (TCS) may be required upon failing medical therapy. The ProtekDuo® dual lumen cannula provides a minimally invasive option for (TCS) through a groin-free internal jugular vein approach. We present the largest patient series to date using the ProtekDuo® cannula as temporary right ventricular assist device (t-RVAD) in RHF after acute myocardial infarction (MI). Methods and results From July 2016 to November 2019, 10 patients underwent t-RVAD implantation for RHF following acute MI. Transthoracic and transoesophageal echocardiography were performed in all patients to assess cardiac function, with a particular focus on RV function. Cumulative 30-day survival was 60%. Mean TAPSE was 6.4 ± 3.1 mm, mean fractional area change was 12.1 ± 4.2%, and mean right ventricular end diastolic area was 19.8 ± 2.7 cm 2. Mean implantation time was 32.8 ± 8.3 min. Mean interval after first cardiac intervention was 4.6 ± 5.8 days. Mean t-RVAD time was 10.0 ± 7.4 days with a significant reduction in central venous pressure 19.3 ± 2.7 vs. 8.2 ± 2.6 mmHg, P < 0.001 and a significant increase in central venous saturation 52.8 ± 15.6 vs. 80.0 ± 6.0%, P < 0.001. Mean intensive care unit stay was 18.6 ± 12.2 days. Four patients were weaned from TCS. Two patients were bridged to a long-term paracorporeal RVAD. There were no t-RVAD associated complications. Causes of death (n = 4) were multiorgan failure, electromechanical dissociation, and haemorrhagic stroke. Mean follow-up time was 96.0 ± 107.6 days. No independent predictors of mortality were identified in univariate analysis. Conclusions We show that groin-free, percutaneous implantation of the ProtekDuo® cannula is a feasible and safe tool for TCS in acute RHF post-MI. This approach provides the advantages of percutaneous implantation including complete mobilization and non-surgical bedside explantation, as well as the option for adding an oxygenator to the t-RVAD circuit.

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ECPELLA 2.0—Minimally invasive biventricular groin‐free full mechanical circulatory support with Impella 5.0/5.5 pump and ProtekDuo cannula as a bridge‐to‐bridge concept: A first‐in‐man method description

Cited by 28 publications

References 14 publications

MitraClip implantation followed by insertion of a left ventricular assist device in patients with advanced heart failure

MitraClip implantation followed by insertion of a left ventricular assist device in patients with advanced heart failure

Acquired tracheomalacia due to aortic aneurysm managed with venopulmonary extracorporeal membrane oxygenation for perioperative support

Temporary right ventricular circulatory support following right ventricular infarction: results of a groin‐free approach

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