Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure

Navin K. Kapur*, Vikram Paruchuri, Ravikiran Korabathina, Ramzi Al-Mohammdi, James O. Mudd, Jordan Prutkin, Michele Esposito, Ameer Shah, Michael S. Kiernan, Candice Sech, Duc Thinh Pham, Marvin A. Konstam, David Denofrio

*Corresponding author for this work

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

Background: Medically refractory right ventricular failure (MR-RVF) is associated with high in-hospital mortality and is managed with surgical assist devices, atrial septostomy, or extracorporeal membrane oxygenation. This study explored the hemodynamic effect associated with a percutaneous RV support device (pRVSD) for MR-RVF. Methods: Between 2008 and 2010, 9 patients with MR-RVF, defined as cardiogenic shock despite maximal medical therapy, were treated with a pRVSD. Medical records were reviewed for demographics, hemodynamic and laboratory data, and details of pRVSD implantation. Results: MR-RVF was due to severe sepsis in 1 patient (11.1%), post-cardiotomy syndrome in 2 (22.2%), and acute inferior wall myocardial infarction (IWMI) in 6 (66.7%). Five patients underwent right internal jugular-to-femoral cannulation, and 4 required bifemoral cannulation. No intra-procedural deaths or major vascular complications requiring surgical or peripheral intervention occurred. Time from admission to pRVSD implantation was 2.9 ± 3.3 days, with an average of 6516 ± 698 rotations/min, providing flow at 3.3 ± 0.4 liters/min. Mean duration of pRVSD activation was 3.1 ± 1.8 days. Compared with pre-procedural values, mean arterial pressure (57 ± 7 vs 75 ± 19 mm Hg, p < 0.05), right atrial pressure (22 ± 3 vs 15 ± 6 mm Hg, p < 0.05), cardiac index (1.5 ± 0.4 vs 2.3 ± 0.5 liters/min/m 2, p < 0.05), mixed venous oxygen saturation (40 ± 14 vs 58 ± 4 percent, p < 0.05), and RV stroke work (3.4 ± 3.9 vs 9.7 ± 6.8 g · m/beat, p < 0.05) improved significantly within 24 hours of pRVSD implantation. In-hospital mortality was 44% (n = 4). Time from admission to pRVSD placement was lower in patients who survived to hospital discharge (0.9 ± 0.8 days) vs non-survivors (4.8 ± 3.5 days; p = 0.04). All survivors presented with IWMI. Conclusion: Use of a pRVSD for MR-RVF is feasible and associated with improved hemodynamics. Algorithms promoting earlier pRVSD use in MR-RVF warrant further investigation.

Original languageEnglish (US)
Pages (from-to)1360-1367
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number12
DOIs
Publication statusPublished - Dec 1 2011

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Keywords

  • invasive hemodynamics
  • mechanical circulatory support
  • right ventricle

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Kapur, N. K., Paruchuri, V., Korabathina, R., Al-Mohammdi, R., Mudd, J. O., Prutkin, J., ... Denofrio, D. (2011). Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure. Journal of Heart and Lung Transplantation, 30(12), 1360-1367. https://doi.org/10.1016/j.healun.2011.07.005