Minimally Invasive Mechanical Circulatory Support Through the Perioperative Pulmonary Thromboendarterectomy Period: A Case Report

2020 ◽  
Vol 15 (2) ◽  
pp. 173-176 ◽  
Author(s):  
Alexander M. Schurman ◽  
Michael T. Cain ◽  
David L. Joyce ◽  
Lucian A. Durham ◽  
David Ishizawar ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Mechanical Circulatory Support ◽  
Pulseless Electrical Activity ◽  
Right Ventricular Dysfunction ◽  
Right Heart Failure ◽  
Spontaneous Circulation ◽  
Circulatory Support ◽  
Salvage Procedure ◽  
Pulmonary Thromboendarterectomy ◽  
Successful Recovery

A 64-year-old man being evaluated for pulmonary thromboendarterectomy (PTE) preoperatively experienced pulseless electrical activity secondary to right ventricular failure while undergoing bronchoscopy. After return of spontaneous circulation, a percutaneous right ventricular assist device (RVAD) was placed through the right internal jugular vein. He continued on right ventricular support with demonstration of right ventricular recovery over the following 8 days, and subsequently underwent PTE for treatment of his primary condition. He recovered and was weaned from his RVAD support uneventfully. The need for RVAD support has traditionally been a contraindication for PTE; however, circulatory assist devices have been used as a salvage procedure for right-heart failure after PTE. This case highlights the potential for percutaneous mechanical circulatory support in treating severe perioperative right ventricular dysfunction, and to facilitate successful recovery in patients undergoing PTE.

scholarly journals Predictors of late right heart failure after mechanical circulatory support

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Felix ◽  
M.I.F Oerlemans ◽  
F.W Asselbergs ◽  
L.W Van Laake ◽  
N De Jonge
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Right Ventricular ◽  
Mechanical Circulatory Support ◽  
Cox Regression ◽  
Right Heart Failure ◽  
Index Admission ◽  
Circulatory Support ◽  
Right Heart

Abstract Introduction Right heart failure (RHF) is associated with a worse outcome in mechanical circulatory support (MCS). Several studies have identified risk factors for RHF shortly after MCS, though information about late RHF is limited. Purpose We aimed to identify risk factors for late RHF in patients with MCS, implanted as a bridge to heart transplantation. Methods Data of all patients, who were successfully discharged after MCS implantation in a University Medical Center between 2006–2019 were included and follow-up was completed until March 2019. Late RHF was defined as the occurrence of right ventricular dysfunction associated with symptoms, including jugular venous distension, hepatic congestion and peripheral edema during MCS support, if diagnosed after the index admission for MCS implantation. The primary end point was the diagnosis of late RHF in combination with the need for intensification of diuretics (either with or without hospitalization) and/or the need for inotropes and/or right ventricular assist device. Univariable and multivariable Cox regression analyses were performed to identify risk factors for late RHF. Results 262 patients (66% male, mean age 51±13 years) had a mean follow-up of 901±643 days. 49 (18.7%) patients suffered from late RHF after a median of 363 (IQR 131–1001) days. Multivariable risk factors for late RHF were a higher body mass index (hazard ratio (HR) 1.05; CI 1.00–1.11), a history of atrial fibrillation (AF) prior to the operation (HR 2.11; CI 1.12–3.96), a lower (i.e. clinically worse) INTERMACS profile and a longer duration on the intensive care unit (HR 1.03; CI 1.00–1.06) during the index admission for MCS implantation (Table 1). The occurrence of early RHF was not associated with late RHF (p=0.211). Conclusion Late RHF is a clinically important adverse event in MCS, affecting approximately 20% of patients. Risk factors associated with late RHF most relate to the severity of the clinical situation at the time of implantation. Funding Acknowledgement Type of funding source: None

Preoperative Strategies for Optimizing Mechanical Circulatory Support

2019 ◽  
pp. 41-46
Author(s):  
Evan C. Klein ◽  
Mitchell T. Saltzberg
Keyword(s):  
Right Ventricular ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Preoperative Treatment ◽  
Risk Models ◽  
Organ Systems ◽  
The Status ◽  
Ventricular Support ◽  
And Function ◽  
Postsurgical Outcomes

Several validated risk models can help determine whether patients with advanced heart failure should be considered for mechanical circulatory support based on its potential survival advantage. Once a patient is a candidate for device therapy, an understanding of these risk models can help inform decisions about modifying risk factors to provide the best postsurgical outcomes. Specific preoperative factors that can be addressed include the adequacy of perfusion, volume status, and the status of non-cardiac organ systems (e.g., the pulmonary, infectious, hematologic, renal systems). Additionally, an understanding of preoperative right ventricular hemodynamics and function can help alert providers to patients with an increased need for postoperative right-ventricular support. The chapter reviews several risk-stratification models, as well as the approach used by the authors’ institution to optimize the preoperative treatment of patients before implementing mechanical circulatory support.

scholarly journals Using aortic arch short axis views during transesophageal echocardiographic examination facilitates right ventricular assist device imaging

2021 ◽  
Author(s):  
Alyssa Tutunjian ◽  
Jamel Ortoleva ◽  
Yong Zhan ◽  
Frederick Chen ◽  
Gregory Couper ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Aortic Arch ◽  
Mechanical Circulatory Support ◽  
Subsequent Development ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Short Axis ◽  
Ventricular Assist ◽  
Echocardiographic Examination ◽  
Right Ventricular Assist Device

Given the increased need for mechanical circulatory support and subsequent development of right ventricular assist devices (RVAD), appropriate imaging needs to be described to facilitate care in patients with cardiogenic shock and heart failure. We present three cases in which the upper esophageal aortic arch short axis (UE AA SAX) view on transesophageal echocardiography (TEE) was utilized to effectively image RVADs: to confirm normal positioning, to detect and guide repositioning, and to visualize malfunction. These cases support the importance of the UE AA SAX TEE view in RVAD outflow imaging and, when obtainable, should be included in routine RVAD assessment.

scholarly journals Implanted Hemodynamic Monitoring in Management of Significant Right Heart Failure before and after Left Ventricular Assist Device Implantation: Creation and Maintenance of Fontan Physiology in Severe Right Ventricular Dysfunction

2018 ◽  
Author(s):  
Kevin Yei ◽  
Casey Kaisi ◽  
Rajeev Mohan ◽  
Ajay Srivastava ◽  
J Thomas Heywood
Keyword(s):  
Right Ventricular ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Hemodynamic Monitoring ◽  
Right Ventricular Dysfunction ◽  
Right Heart Failure ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

In the left ventricular assist device (LVAD) population, right ventricular (RV) failure represents a significant cause of morbidity and mortality. It is unclear whether hemodynamic monitoring with the implantable CardioMEMS system can improve outcomes within this population. This case report highlights two patients in our clinic who had CardioMEMS implanted after LVAD, enabling us to modify their medical regimens remotely and more frequently in the management of their RV failure.

scholarly journals Catheter‐based embolectomy prior to right ventricular mechanical circulatory support placement after heart transplantation

2020 ◽  
Vol 7 (5) ◽  
pp. 3215-3218
Author(s):  
Vikrant S. Jagadeesan ◽  
Laura J. Davidson ◽  
Andrei Churyla ◽  
Keith H. Benzuly
Keyword(s):  
Heart Transplantation ◽  
Right Ventricular ◽  
Mechanical Circulatory Support ◽  
Circulatory Support
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