Results of concomitant groin-free percutaneous temporary RVAD support using a centrifugal pump with a double-lumen jugular venous cannula in LVAD patients

Schmack, Bastian; Farag, Mina; Kremer, Jamila; Großekettler, Leonie; Brcic, Andreas; Raake, Philip; Kreußer, Michael M.; Goldwasser, Ranny; Popov, Aron‐Frederik; Mansur, Ashham; Kretzler, Matthias; Ruhparwar, Arjang

doi:10.21037/jtd.2018.11.121

Cited by 32 publications

(52 citation statements)

References 22 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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“…Owing to the patient's status, the results of a TAH procedure were regarded as unfavourable in the patient as surgical trauma would have been unequally larger than LVAD surgery. Within our heart failure heart team, we assessed this patient to be a good candidate for durable LVAD support with temporary groin‐free RVAD, 3 assuming the acute COVID‐19 infection to be one major and reversible issue impairing the RV. However, the high haemocompatibility of the HeartMate 3 device remains outstanding.…”

Section: Discussionmentioning

confidence: 99%

“…At that time, NT-proBNP was 163 837 pg/mL, C-reactive protein raised to 24.5 mg/dL, IL-6 to 124 pg/mL, and PCT to 7.73 ng/mL ( Table S1). The patient was referred to heart surgery with LVAD as therapeutic bridge-to-transplant option, percutaneous temporary right ventricular assist device (RVAD) implantation, 3 and tricuspid repair on Hospital Day 13. Hereafter, weaning from the RVAD was successful 2 weeks after implantation.…”

Section: Case Report Clinical Manifestation and Evolutionmentioning

confidence: 99%

Ventricular assist device for a coronavirus disease 2019‐affected heart

et al. 2020

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Coronavirus disease 2019 (COVID‐19) is challenging the care for cardiovascular patients, resulting in serious consequences with increasing mortality in pre‐diseased heart failure patients. In the current state of the pandemic, the physiopathology of COVID‐19 affecting pre‐diseased hearts and the management of terminal heart failure in COVID‐19 patients remain unclear. We outline the findings of a young COVID‐19 patient suffering from idiopathic cardiomyopathy who was treated for acute multi‐organ failure and required cardiac surgery with implantation of a temporary right ventricular and durable left ventricular assist device (LVAD). For deeper translational insights, we used in‐depth tissue analysis by electron and light sheet fluorescence microscopy revealing evidence for spatial distribution of severe acute respiratory syndrome coronavirus 2 in the heart. This indicates that in‐depth analysis may represent a valuable tool in understanding indistinct clinical cases. We conclude that COVID‐19 directly affects pre‐diseased hearts, but the consequences can be treated successfully with LVAD implantation.

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“…On the first postoperative day (POD), the patient was weaned from the respirator and full mobilization continued. The temporary RVAD was weaned according to our protocols 10 and explanted at the bedside on POD 5.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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Background: Cardiogenic shock (CS) from biventricular heart failure that requires acute mechanical circulatory support (MCS) is associated with high mortality.Different MCS methods and techniques have emerged as a standard of care in CS.Nevertheless, the routine MCS approach carries multiple limitations such as limb ischemia, missing of left ventricular unloading and immobilization.We describe a method to establish a groin-free full support MCS in patients with CS without the need for thoracotomy. This is the first report of the ECPELLA 2.0 concept, a peripheral groin-free biventricular MCS in patients with acute CS.Methods and results: We discuss two patients in acute CS (INTERMACS I) treated with two peripheral MCS devices (Impella 5.0 or 5.5 surgically via an axillary artery and ProtekDuo cannula percutaneously via a right internal jugular vein) as a bridge before the implantation of a durable left ventricular assist device (LVAD).Biventricular assist device (BIVAD)-support duration was 9 and 15 days and both of the patients were successfully bridged to a durable LVAD. As our BIVAD-concept is groinfree, the patients started full mobilization as early as they were weaned from the respirator 2 days after the BIVAD-implantation. ECPELLA 2.0 provides a high cardiac output, right and left ventricular unloading with end-organ recovery and a possibility of administration of a membrane oxygenator. There were no device-related complications. Conclusion:The ECPELLA 2.0 biventricular support concept for patients suffering from an acute CS. Allows for rapid extubation, mobilization, and physical exercise while on full support. Additional application of a membrane oxygenator is easily feasible if required.

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Results of concomitant groin-free percutaneous temporary RVAD support using a centrifugal pump with a double-lumen jugular venous cannula in LVAD patients

Cited by 32 publications

References 22 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

Ventricular assist device for a coronavirus disease 2019‐affected heart

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

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