Disclosure
This presentation describes the off-label use of the Centrimag™ Ventricular Assist Device (Abbott).
Objectives
Right ventricular (RV) failure is a life-threatening complication after left ventricular assist device (LVAD) implantation. Increasingly, temporary right ventricular assist devices (RVAD) are used to support postoperative right heart failure and cardiogenic shock. Typically, temporary RVAD placement is limited by the need for delayed sternal closure, reoperative sternotomy for removal, or restricted patient mobility due to a femoral venous catheter.
Methods
The authors describe a novel technique for the placement of a temporary RVAD that does not rely on femoral central venous access and can be discontinued using conscious sedation and local anesthetic.
Results
A durable LVAD is placed through a median sternotomy after initiation of central cardiopulmonary bypass. In the case of RV failure, an 8 mm Dacron graft is anastomosed to the main pulmonary artery and a 14 mm Dacron graft is sewn to the right atrial appendage. The conduits are then tunneled out through the skin between the 2nd and 3rd rib spaces bilaterally. Cannulae for the extracorporeal RVAD are then placed through the conduits using echocardiographic guidance for optimal positioning. Cardiopulmonary bypass is weaned as both VAD flows are titrated, and the sternum is closed in the standard fashion. Patients are transported to the intensive care unit (ICU) where they are extubated and vasoactive infusions are weaned as tolerated. Patients are mobilized and begin physical rehabilitation on postoperative day one. When right ventricular support is no longer required, the cannulae are removed using minimal sedation and local anesthetic.
Conclusion
The authors report a novel technique for temporary right ventricular support after LVAD placement that allows for early patient mobilization and can be discontinued in the ICU.
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Congratulations on this nice technique.
However, a similar technique has already been described by Cohn et al in 2007:
Bedside Right Ventricular Assist Device Removal
in the Conscious Patient
A technique is described for simple bedside removal of a
right ventricular assist device system from a conscious
patient. This technique allows weaning from the support
of the right ventricular assist device without the confounding
hemodynamic challenges of positive pressure
ventilation and sternal closure.
(Ann Thorac Surg 2007;83:1556 –7)
© 2007 by The Society of Thoracic Surgeons