Thorac Cardiovasc Surg 2013; 61 - OP50
DOI: 10.1055/s-0032-1332289

Therapy concept of the failing right ventricle by patients with permanent left ventricular device

H Bushnaq 1, D Metz 1, B Hofman 1, K Krohe 1, RE Silber 1, C Raspè 2
  • 1Universitätsklinikum Halle, Klinik für Herz- und Thoraxchirurgie, Halle, Germany
  • 2Universitätsklinikum Halle, Klinik für Anästhesiologie und operative Intensivmedizin, Halle, Germany

Aims: Left ventricle assist device (LVAD) is an established therapy option for patients in end stage heart failure. Right heart failure in LVAD Therapy is a serious Complication which increase the perioperative mortality. In addition to the catecholamines therapy, temporary right ventricle assist device (RVAD) seems to by a supplementary potential therapy option.

Methods: The aim of this study was to report a modified cannulation technique and the results for implanting temporary RVAD in 22 patients during LVAD implantation for temporary support the failed right ventricle. The inflow cannula was inserted transcutaneously via direct puncture of the femoral vein and advanced in to superior vena cava with the Sildinge technique. In our modified technique, we suture a 10 mm Dacron prosthesis end-to-side to the closed main pulmonary artery without punching and clamping it. Tunneling the Graft extracorporeal left parasternal in the third intercostal space. Advance the outflow cannula through the graft in to the main pulmonary artery and tied it up. Both of them were connected with the temporary RVAD. The devices were explanted using minimally invasive approach in the intensive care unit under local anesthesia.

Results: Between 2008 and 2012 received 22 Patients a temporary RVAD while the LVAD implantation. The mean patients age was 53 ± 11.9 years and 82% were male. All of them were successfully weaned from the temporary RVAD independent of the right ventricular function. The average duration of support was 8 ± 3.8 days. The concept of RVAD weaning is done by optimizing the hemodynamic of the right ventricle due to reduction in preload and increased afterload. The advantages of this technique are the possibility of off-pump implantation without clamping and punching the main pulmonary artery. The minimal invasive explantation can by done in the intensive care unit under local anesthesia, resternotomy is not necessary.

Conclusion: The modified technique is a simpler, safer and more minimally invasive method for selected LVAD patients supported by temporary RVAD.