Transapical ProtekDuo Rapid Deployment Cannula as Temporary Left Ventricular Assist Device in a Jehovah's Witness Patient

Belani, Kiran; Saikus, Christina E.; Schroder, Jacob N.; Klinger, Rebecca Y.

doi:10.1053/j.jvca.2020.12.009

Cited by 10 publications

(9 citation statements)

References 12 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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“…While descriptions of this technique are available, its application and use in clinical practice has largely been confined to case reports of exceptional patient circumstances where other modes of support have been deemed unsuitable. 9 Left ventricular cannulation via the method described allowed for full systemic support in patients with cardiogenic shock with the use of an extracorporeal magnetically levitated centrifugal pump. For patients with pulmonary dysfunction, an oxygenator could easily be added to this circuit and further, for patients with biventricular failure, a second dual lumen cannula could be inserted into the right ventricle via the right internal jugular vein and attached to an additional pump to provide biventricular support.…”

Section: Discussionmentioning

confidence: 99%

Transapical Cannulation With a Dual Lumen Cannula for Mechanical Circulatory Support in Cardiogenic Shock

Singh

Chandel²,

Paras³

et al. 2022

ASAIO Journal

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Temporary mechanical circulatory support can be delivered through a variety of techniques, including percutaneous left ventricular assist devices, surgically implanted rotary pumps, and veno-arterial extracorporeal membrane oxygenation. However, limitations include the effects of high afterload, intravascular hemolysis, patient vascular anatomy, surgical morbidity, and limited patient mobility which can hinder patient recovery. We describe a series of patients managed with transapical left ventricular mechanical circulatory support using a dual lumen cannula for the management of cardiogenic shock as a bridge to recovery or definitive decision. This support strategy may represent an additional option in the care for patients with cardiogenic shock that can provide full temporary anterograde mechanical circulatory support while potentially improving patient mobility and minimizing device-related complications.

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“…The rapid deployment (RD) version of the cannula was used because the drainage and perfusion holes are closer together compared with other versions of the cannula (8.7 cm apart vs 17.5 and 21.9 cm). 5 With the tip of the ProtekDuo RD cannula in the LA, the drainage holes were positioned at the RA–superior vena cava junction. The right femoral vein was accessed for the VeriSight intracardiac echocardiography (ICE) catheter (Philips, Amsterdam, The Netherlands).…”

Section: Methodsmentioning

confidence: 99%

Percutaneous Transseptal Extracorporeal Membrane Oxygenation to Rescue a Failing Right Ventricle in an Animal Model

Castillo-Larios,

Pollak,

Chaudhary

et al. 2023

Innovations�(Phila)

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Objective: We tested the feasibility and effectiveness of a percutaneous atrial transseptal extracorporeal membrane oxygenation (ECMO) cannulation strategy in a right ventricular failure (RVF) model. Methods: We performed 4 nonsurvival porcine experiments. Percutaneous transseptal access was achieved using a steerable introducer. For guidance, we used fluoroscopy, transesophageal echocardiogram (TEE), and intracardiac echocardiography (ICE). A ProtekDuo rapid deployment cannula (LivaNova, London, UK) was advanced across the septum into the left atrium by 2 to 3 cm. Pulmonary hypertension (PH) was induced by partially clamping the pulmonary artery. ECMO flow was cycled from high (2 to 3 L/min) to low (0.2 to 0.3 L/min) over 2 to 3 hours. Results: Transseptal access using TEE and fluoroscopy was successful in 1 animal and unsuccessful in 1 animal. ICE provided optimal visualization for the remaining 2 animals. Mean arterial pressure (MAP) was associated immediately and consistently with high versus low ECMO flow rate (mean difference: 29 ± 3.1 mm Hg, P = 0.004) but was not restored to baseline values. RV pressure values were dynamic. Given time to equilibrate, mean RV pressure was restored to a baseline level. Conclusions: Percutaneous right atrium to left atrium transseptal cannulation relieved PH-RVF. MAP was restored to a viable level, and mean RV pressure was restored to a baseline level. Transseptal ECMO shows promise as a cannulation strategy to bridge patients with PH-RVF to lung transplant.

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Transapical ProtekDuo Rapid Deployment Cannula as Temporary Left Ventricular Assist Device in a Jehovah's Witness Patient

Cited by 10 publications

References 12 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

Transapical Cannulation With a Dual Lumen Cannula for Mechanical Circulatory Support in Cardiogenic Shock

Percutaneous Transseptal Extracorporeal Membrane Oxygenation to Rescue a Failing Right Ventricle in an Animal Model

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