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Outcomes of Minimally Invasive Temporary Right Ventricular Assist Device Support for Acute Right Ventricular Failure During Minimally Invasive Left Ventricular Assist Device Implantation

Schaefer, Andreas*; Reichart, Daniel*; Bernhardt, Alexander M.*; Kubik, Mathias*†; Barten, Markus J.*; Wagner, Florian M.*; Reichenspurner, Hermann*; Philipp, Sebastian A.; Deuse, Tobias

doi: 10.1097/MAT.0000000000000526
Adult Circulatory Support

Right ventricular failure (RVF) may still occur despite the benefits of minimally invasive left ventricular assist device (MI-LVAD) implantation. Our center strategy aims to avoid aggressive postoperative inotrope use by using mechanical support to facilitate right ventricle recovery and adaptation. We herein report first outcomes of patients with minimally invasive temporary right ventricular assist device (MI-t-RVAD) support for RVF during MI-LVAD implantation. Right ventricular failure was defined as requiring more than moderate inotopic support after weaning from cardiopulmonary bypass according to Interagency Registry for Mechanically Assisted Circulatory Support adverse event definitions. All patients requiring MI-t-RVAD support for RVF during MI-LVAD implantation between January, 2012 and April, 2016 were retrospectively reviewed. Clinical endpoints were death or unsuccessful RVAD weaning. Overall 10 patients (90% male, mean age 49.6 ± 14.8 years) underwent MI-t-RVAD implantation. Duration of MI-t-RVAD support was 16.2 ± 11.6 days. Right ventricular assist device weaning and subsequent uneventful awake device explantation was successful in all cases. The 30 day survival was 80%. Our results confirm safety and feasibility of MI-t-RVAD support for acute RVF in the setting of MI-LVAD implantation. The potential benefits of this strategy are more stable hemodynamics in the first postoperative days that usually are crucial for LVAD patients and reduced inotrope requirement.

From the *Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany; Department of Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Cardiology and Intensive Care Medicine, Elbe Clinic Stade, Niedersachsen, Germany; and §Department of Cardiac Surgery, Division of Adult Cardiothoracic Surgery, Cardiac Surgery, University of California San Francisco, San Francisco, California.

Submitted for consideration August 2016; accepted for publication in revised form January 2017.

Andreas Schaefer, Daniel Reichart, Sebastian A. Philipp, and Tobias Deuse contributed equally to this work.

Disclosure: The authors have no conflicts of interest to report.

A.M. Bernhardt received grant/research support from Heartware; T. Deuse received financial and material support from Heartware. All other authors have nothing to declare.

Correspondence: Andreas Schaefer, University Heart Center Hamburg, Martinistraße 52, D-20246 Hamburg, Germany. Email: and.schaefer@uke.de.

Copyright © 2017 by the American Society for Artificial Internal Organs