Minimally Invasive Right Ventricular Assist Device Implantation in a Patient with HeartWare left ventricular Assist Device

Abstract

Many centers reported positive outcome after left ventricular assist devices (LVADs) implantation using a minimally invasive approach. The main drawback of this minimally invasive approach is the feasibility of right ventricular assist device (RVAD) implantation with direct cannulation of the pulmonary artery in cases of perioperative right ventricular failure (RVF). We report our experience with a 41-year-old male patient who was supported with a temporary RVAD using J-sternotomy approach for RVF after LVAD implantation. No technical issue was encountered, and the patient's condition stabilized immediately after RVAD implantation. However, several days later, the patient developed severe septic shock caused by pneumonia and died on the postoperative day 15 after RVAD implantation.

Minimally invasive single-incision temporary biventricular assist device

“…Although minimally invasive left ventricular assist device insertion has been widely reported, 1 there are few publications regarding less-invasive insertion of short-term support devices. 2–4 Most new devices are percutaneous; 5 however, they need a certain vessel size to accommodate them, and for this and other reasons, many patients are not suitable candidates. In our case, the arteries were considered too small for the device or a vascular graft.…”

Minimally Invasive Temporary Right Ventricular Assist Device for Acute Right Ventricular Failure

“…Additionally, newer, catheter‐based MCS devices are able to generate increased blood flows for patients with left and right ventricular failure competing with the traditional form of temporary MCS, veno‐arterial (VA) extracorporeal membrane oxygenators (ECMO). ECMO‐based therapies are frequently placed for postcardiotomy failure, where a central cannulation strategy is most practical . However, in patients who require acute, temporary MCS for non‐postcardiotomy left ventricular (LV) or right ventricular (RV) failure, biventricular failure and/or respiratory failure, peripheral ECMO‐based therapies, such as right ventricular assist device (RVAD), remain our preferred strategy.…”

“…ECMO-based therapies are frequently placed for postcardiotomy failure, where a central cannulation strategy is most practical. [3][4][5] However, in patients who require acute, temporary MCS for non-postcardiotomy left ventricular (LV) or right ventricular (RV) failure, biventricular failure and/or respiratory failure, peripheral ECMO-based therapies, such as right ventricular assist device (RVAD), remain our preferred strategy.…”