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

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. J Heart Lung Transplant 2011;30:1360-7 (C) 2011 International Society for Heart and Lung Transplantation. All rights reserved.