A novel approach to percutaneous right-ventricular mechanical support

We report our initial experience with our newly developed percutaneous right-ventricular assist device (VAD) with CentriMag (perc CM-RVAD). A flexible outflow cannula placed from the right internal jugular vein to the pulmonary artery and an inflow cannula placed from the femoral vein to the right atrium constituted the perc CM-RVAD. When needed, biventricular support was provided with left VAD (LVAD), either with a percutaneous LVAD placed through axillary or femoral artery access or with a fully implantable LVAD. Between January 2009 and June 2010, all of the attempted patients successfully received perc CM-RVAD (n = 8). Mean blood pressure, heart rate, and central venous pressure showed a trend toward improvement after the perc CM-RVAD, with less inotrope/vasopressor requirement. Mixed venous oxygen saturation (SvO(2)) increased significantly from 64 +/- 20 Torr to 78 +/- 6 Torr (P < 0.01). The percutaneous VADs were explanted after myocardial recovery in seven patients; however, in three of these, perc CM-RVAD was used as a temporary bridge to other devices. One patient was bridged to a surgical biventricular assist device (BiVAD) and transferred back to the referring hospital on support. One death occurred due to multiple-organ failure 8 days after explantation of the RVAD with recovery. Perc CM-RVAD was feasible and provided hemodynamic improvement.