First‐in‐man successful use of the SPECTRUM percutaneous dual‐stage right ventricle and right atrium to pulmonary artery ventricular assist device

Abstract

Background: Over the past decade, several minimally invasive mechanical support devices have been introduced into clinical practice to support the right ventricle (RV). Percutaneous cannulas are easy to insert, minimally invasive, and treat acute RV failure rapidly. In December 2021, the Food and Drug Administration approved a new 31 French dual lumen single cannula for use as a right ventricular assist device. Aims: Descirbe the use of the new dual lumen percutaneous right ventricular assist device (RVAD) cannula. Material and Methods: Deployment of the RVAD can be done surgically or percutaneously. This cannula, manufactured by Spectrum, is dual staged. It has inflow ports positioned both in the right atrium (RA) as well as the RV for maximal drainage of the right heart. The distal end of the cannula which includes the outflow port is positioned in the pulmonary artery (PA). Results: Deployment of the Spectrum RVAD can be done percutaneously with transesophageal and flouroscopy guidence. Cannulation requires requisite wire skills in order to navigate into the main pulmonary artery. Utilization of this cannula can be done in acute RV failure secondary to ischemia, post cardiotomy shock, acute respiratory failure or other causes of isolated RV failure. Discussion: The dual stage drainage design optimizes venous drainage as well as limits suck-down events. Theoretically, direct RV decompression also decreases RV dilation and wall tension, and facilitates improved transmural pressure gradient to reduce RV strain. Conclusion: Here we describe the first-in-man successful use of the dual-stage RA and RV to PA Spectrum cannula in a patient with severe COVID acute respiratory distress syndrome and acute right ventricular failure, bridged to recovery.

Arterial oxygen pressure during veno-venous extracorporeal membrane oxygenation may be increased by advancing the tip of the drainage cannula into the superior vena cava: a case report

“…In Europa and the United States, ProtekDUO ™ and Spectrum Medical's dual lumen cannula systems are available, and in these the drainage port is open to the RA and the reinfusion port is open to the pulmonary artery so that the right ventricle is bypassed [veno-pulmonary artery ECMO (V-P ECMO)] [13,14]. In V-P ECMO, recirculation should theoretically be 0% and it can provide support for right heart failure by acting as a percutaneous right ventricular assist device.…”

“…ProtekDUO ™ has a lineup of 31Fr and 29Fr and Spectrum Medical's dual lumen cannula has a lineup of 31Fr, 27Fr and 24Fr for adult use. However, the actual effective size of the drainage port is even smaller because the reinfusion port is positioned in the center of the lumen of the cannula [14,15]. As with the Avalon Elite ™ , sufficient ECMO flow may not be achieved, and a veno-venopulmonary (V-VP) configuration with the addition of another large drainage cannula has been proposed [16].…”