Hemolysis and Pulmonary Insufficiency following Right Ventricular Assist Device Implantation

We report a case of severe hemolysis and pulmonary valve insufficiency (PI) following right ventricular support using a paracorporeal pneumatic pump (Abiomed, Danvers, MA, USA). We speculate that the high velocity jet of blood emanating from the outflow cannula caused turbulence above the pulmonary valve, leading to PI and hemolysis. Despite the growing number of implanted ventricular assist devices, we could find no report in the literature describing pulmonary valve insufficiency secondary to right ventricular assist device (RVAD) placement. Fortunately, in this case, right ventricular function recovered sufficiently after seven days of support, allowing explantation of the device and resolution of PI and hemolysis.

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Optimization with levosimendan improves outcomes after left ventricular assist device implantation

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz159 ◽

2019 ◽

Vol 57 (1) ◽

pp. 176-182

Author(s):

Sinan Sabit Kocabeyoglu ◽

Umit Kervan ◽

Dogan Emre Sert ◽

Mehmet Karahan ◽

Emre Aygun ◽

...

Keyword(s):

Right Ventricular ◽

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Assist Device ◽

Ventricular Assist ◽

Device Implantation ◽

Left Ventricular Assist ◽

Right Ventricular Assist Device

Abstract OBJECTIVES The aim of this study was to examine the haemodynamic effects of preoperative levosimendan infusion in patients who underwent left ventricular assist device implantation and evaluate the prognoses. METHODS Between May 2013 and October 2018, 85 adult patients who underwent left ventricular assist device implantation were included; 44 and 41 patients suffered from dilated cardiomyopathy and ischaemic cardiomyopathy, respectively. Patients were divided into 2 groups: group A (58 patients) included those who received levosimendan infusion in addition to other inotropes and group B (27 patients) included those who received inotropic agents other than levosimendan. Levosimendan infusion was started at a dose of 0.1 µg⋅kg−1⋅min−1 for a maximum of 48 h without a bolus. The primary outcome was early right ventricular failure (RVF). The secondary outcomes were in-hospital mortality, need for right ventricular assist device, late RVF and recovery of end-organ functions. The safety end points of levosimendan included hypotension, atrial fibrillation, ventricular tachycardia or fibrillation and resuscitated cardiac arrest. RESULTS Patient characteristics were similar in both groups. No significant differences between groups were observed in the rates of early mortality, RVF, need for right ventricular assist device, cardiopulmonary bypass time and intensive care unit stay. Survival rates at 30 days, 1 year and 3 years and freedom from late RVF were similar between the groups. Administration of levosimendan was safe, generally well-tolerated and not interrupted because of side effects. CONCLUSIONS Levosimendan therapy was well-tolerated in patients who received permanent left ventricular assist devices. Combined preoperative therapy with inotropes and levosimendan significantly improves end-organ functions.

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Right Ventricular Assist Device Configuration for Remote Decannulation

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000285 ◽

2016 ◽

Vol 11 (3) ◽

pp. 225-228 ◽

Cited By ~ 3

Author(s):

Vakhtang Tchantchaleishvili ◽

Fabio Sagebin ◽

Howard Todd Massey

Keyword(s):

Right Ventricular ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Assist Device ◽

Ventricular Assist ◽

Pulmonary Vasodilators ◽

Device Implantation ◽

Increased Risk ◽

Right Ventricular Assist Device

Preoperative risk factors, intraoperative fluid shifts, and transfusions place patients at increased risk for right ventricular failure during left ventricular assist device implantation. Despite aggressive use of inotropes and pulmonary vasodilators, in severe cases of RV failure, a right ventricular assist device may be required. For the past several years, we have been implanting right ventricular assist devices in the presented configuration, allowing less invasive removal without sternotomy. The method is presented herein.

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Long-term continuous flow mechanical biventricular support: 9 years and counting

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz231 ◽

2019 ◽

Vol 30 (1) ◽

pp. 81-84

Author(s):

Einar Gude ◽

Tom N Hoel ◽

Gro Sørensen ◽

Kaspar Broch ◽

Anders Meyer ◽

...

Keyword(s):

Right Ventricular ◽

Ventricular Assist Device ◽

Continuous Flow ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Assist Device ◽

Ventricular Assist ◽

Left Ventricular Assist ◽

Right Ventricular Assist Device

Abstract We report 2 continuous flow HeartWareTM left ventricular assist devices successfully used in a patient with advanced heart failure of giant cell myocarditis origin in a biventricular configuration. Despite technical challenges of adapting a left ventricular assist device engineered for systemic pressure to function as a right ventricular assist device, the addition of dynamic banding on the right ventricular assist device outflow graft allowed successful adaptation of afterload. This patient has now been on biventricular configuration support for 9 years, and remains stable to this day.

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