Temporary extracorporeal left ventricular support with transapical ProtekDuo cannula

Goodwin, Matthew L.; Roberts, Sophia; Lampert, Brent C.; Whitson, Bryan A.

doi:10.1016/j.xjtc.2020.11.004

Cited by 10 publications

(8 citation statements)

References 3 publications

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“… 9 Therefore, it was necessary to reconsider and use the ProtekDuo RVAD plus oxygenator to provide oxygenated blood to the patient as well as RV offloading by bypassing the RV. The ProtekDuo is a multi-purpose cannula that has been used and described in several different settings, such as for RVAD, 10 LVAD, 11 , 12 BiVAD (ECPELLA 2.0), 12 , 13 ECMO, or cardiopulmonary bypass (CPB) 14 , 15 support. Default is the V-P configuration with blood drainage from the RA and blood return into the PA. An average blood flow of 4.5 LPM may be achieved.…”

Section: Discussionmentioning

confidence: 99%

The ProtekDuo for percutaneous V-P and V-VP ECMO in patients with COVID-19 ARDS

et al. 2022

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Objective: The ProtekDuo with oxygenator mimics veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) in veno-pulmonary (V-P) configuration. We have recently developed a new configuration by utilizing a 25 Fr multistage femoral venous drainage cannula and by returning oxygenated blood through both lumina of the double lumen ProtekDuo cannula (V-VP configuration), thereby creating partial right ventricular bypass and oxygenated blood flow of up to seven LPM. We investigated our experience with V-P and V-VP ECMO in patients suffering from COVID-19 acute respiratory distress syndrome (ARDS). Methods: Single center, retrospective observational study. Results: Of nine patients, one was initiated on V-A, two on V-P, and six on V-V ECMO. All patients were reconfigured to V-P and five patients in addition had V-VP ECMO configuration. All patients had at least one and up to three circuit exchanges. Patients were on ECMO support between 20 and 122 (55 ± 29) days, were in ICU between 46 and 161 (78 ± 40) days with a total hospital length of stay between 35 and 171 (82 ± 42) days. Six of nine (67%) patients could successfully be weaned off ECMO, survived, and were discharged. Conclusion: The ProtekDuo cannula in V-P configuration provides ECMO blood flow while reducing RV flow, wall-stress and dilatation, as well as oxygen consumption. The V-VP configuration is useful to provide high blood flows of up to seven LPM of oxygenated blood, and partial RV support without over-circulating the pulmonary vascular bed. Our results show that V-P and V-VP ECMO configurations are feasible, have good outcome and are without complications.

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Section: Discussionmentioning

confidence: 99%

The ProtekDuo for percutaneous V-P and V-VP ECMO in patients with COVID-19 ARDS

et al. 2022

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“…With this flow, the aortic valve remained closed and the LV well decompressed. 11 Temporary left ventricular MCS is supposed to decompress the LV and provide adequate forward flow into the aorta and systemic circulation, as it can be achieved with endovascular devices like the Impella or ProtekDuo. In a report by Bellani et al, 12 the authors describe the successful transesophageal echocardiographyguided placement of a ProtekDuo RD via a left ventricular apical approach to provide minimally invasive LV support in a high-risk Jehovah's Witness patient.…”

Section: Protekduo As Lvad In Left Ventricular Failurementioning

confidence: 99%

“…Goodwin et al 11 reported ProtekDuo cannula insertion though the LV apex as described in the technique above to provide temporary left-sided support in a patient designated as INTERMACS profile 1. The cannula provided excellent hemodynamic support without hemolysis or insertion-site bleeding and allowed for end-organ recovery to bridge this patient to a durable LVAD (Figure 2(b)).…”

Section: Protekduo As Lvad In Left Ventricular Failurementioning

confidence: 99%

The novel ProtekDuo ventricular assist device: Configurations, technical aspects, and present evidence

et al. 2022

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The ProtekDuo, single site dual lumen cannula can be used in a multitude of configurations. In the medical literature, the ProtekDuo is described as right ventricular assist device (RVAD), as left ventricular assist device (LVAD), as biventricular assist device (BiVAD) when combined with an Impella device or other LVAD’s, as double lumen drainage cannula on cardiopulmonary bypass (CPB), as RVAD with oxygenator, in veno-pulmonary (V-P) ECMO configuration, venovenous-pulmonary (VV-P) ECMO configuration with additional drainage cannula, and in veno-venopulmonary (V-VP) ECMO configuration as double lumen return cannula. Improvements in flow and oxygenation have been recognized in various settings and need further scientific evaluation. We summarized the above-mentioned configurations, technical aspects, and the present literature available for the ProtekDuo.

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“…7 Moreover, there have been case reports describing the transapical insertion of a dual-lumen cannula for temporary paracorporeal LV support (Figure 1C). 8,9 At our institute, we develop an accessory for durable intracorporal LVADs. The accessory combines the inflow cannula and outflow graft (OG) in a dual-lumen adapter with a transventricular OC across the AV (Figure 1D).…”

Section: Introductionmentioning

confidence: 99%

Longitudinal cardiac dimensions in patients undergoing LVAD implantation

Meissner,

Szvetics,

Galbas

et al. 2024

Artificial Organs

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BackgroundIn conventional left ventricular assist devices (LVAD), a separate outflow graft is sutured to the ascending aorta. Novel device designs may include a transventricular outflow cannula crossing the aortic valve (AV). While transversal ventricular dimensions are well investigated in patients with severe heart failure, little is known about the longitudinal dimensions. These dimensions are, however, particularly critical for the design and development of mechanical circulatory support (MCS) devices with transaortic outflow cannula.MethodsIn an explorative retrospective cohort study at the University Medical Center Freiburg, Germany, the longitudinal cardiac dimensions of patients undergoing computed tomography angiography (CTA) before and, if available, after LVAD implantation were analyzed. Among others, the following dimensions were assessed: (a) apex to AV, (b) apex to mitral valve, (c) AV to sinotubular junction (STJ), (d) apex to STJ, (e) apex to brachiocephalic artery (BCA), and (f) AV to BCA.ResultsIn total, 44 LVAD patients (36 male, age 55.8 years, height 1.75 m) were included. The longitudinal cardiac dimensions were (a) 114.5 ± 12.1 mm, (b) 108.0 ± 12.4 mm, (c) 20.9 ± 2.9, (d) 135.4 ± 13.4 mm, (e) 206.0 ± 18.3, and (f) 91.5 ± 9.8 mm. Postoperatively, (a) and (b) decreased by 31.5% and 39.5%, respectively (N = 14).ConclusionsLongitudinal cardiac dimensions may be reduced by up to 40% after LVAD implantation. A better knowledge of these dimensions and their postoperative alterations in LVAD patients may improve surgical planning and help to design MCS devices with transventricular outflow cannula.

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Temporary extracorporeal left ventricular support with transapical ProtekDuo cannula

Cited by 10 publications

References 3 publications

The ProtekDuo for percutaneous V-P and V-VP ECMO in patients with COVID-19 ARDS

The ProtekDuo for percutaneous V-P and V-VP ECMO in patients with COVID-19 ARDS

The novel ProtekDuo ventricular assist device: Configurations, technical aspects, and present evidence

Longitudinal cardiac dimensions in patients undergoing LVAD implantation

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