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Right ventricular assist device (RVAD): An adjuvant therapy in variety of cardiovascular procedures

Session Poster Session 4

Speaker Maria Molina

Event : Heart Failure 2019

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Cardiovascular Surgery - Transplantation
  • Session type : Poster Session

Authors : M Molina (Philadelphia,US), Y Quiaoit (Philadelphia,US)

Authors:
M Molina1 , Y Quiaoit2 , 1University of Pennsylvania, Cardiovascular Medicine and Cardiothoracic Surgery - Philadelphia - United States of America , 2University of Pennsylvania, Heart Failure/Transplant - Philadelphia - United States of America ,

Citation:

Background: Right ventricular assist devices (RVAD) have been utilized in the treatment of post-cardiotomy right ventricular failure and as an adjunct to left ventricular assist device (LVAD) implantation with reasonable success. 

Purpose: In this case series, we describe outcomes of seven patients treated at our institution with RVAD support for post-cardiotomy RV failure, as an adjunct to LVAD implantation, and as prophylactic RV support for LVAD patients undergoing elective ventricular tachycardia (VT) ablation procedures. 

Methods: Retrospective analysis from 7/2017 to 9/2018 of the seven case series of patients who were supported by temporary right ventricular assist device. Laboratory findings and outcomes were analyzed using descriptive statistics.

Results: Demographics, pertinent clinical details, and outcomes are summarized in Table 1.  Three patients (pts) were treated with RVAD support for post-cardiotomy RV failure; of these, one died of intracranial hemorrhage on the 6th post-operative day.  The remaining 2 pts were successfully decannulated after 33 and 26 days of RVAD support, respectively, and ultimately discharged from the hospital.  Two pts received RVAD support as an adjunct to LVAD implantation; both of these pts were successfully decannulated with improved RV function after 22 and 13 days.  Finally, 2 pts had prophylactic RVAD placement prior to an elective VT ablation procedure; again, these 2 pts were weaned from RVAD support successfully on the 21st and 6th post-procedure days. Post-cardiotomy patients required longer duration of RVAD support (median 26 days) than LVAD pts (median 17.5 days) and pts receiving RVAD support for VT ablation (median 13.5 days).  These pts also had, in general, more post-operative complications including acute renal failure and need for tracheostomy.  Notably, the post-operative course of pts receiving RVAD support for elective ablation procedures was relatively uncomplicated.  This anecdotal finding may support wider use of prophylactic RVAD support in this population, although certainly warrants further investigation. The peak bilirubin values were again higher for the post-cardiotomy group (4.6 mg/dL) compared to the LVAD and VT ablation groups (4.2 mg/dL and 2.7 mg/dL, respectively).  This likely represents the overall higher clinical acuity of the post-cardiotomy patient population.

Conclusion: Our experience supports the notion that early or prophylactic RVAD support may be of particular benefit in certain clinical situations, as patients in our series who received RVAD support in conjunction with LVAD implant or in preparation for VT ablation had fewer complications and shorter duration of support than the post-cardiotomy group.  While these findings merit further investigation, our series confirms that RVAD support is a durable, feasible option for prolonged right ventricular support in a variety of clinical scenarios, successfully bridging many patients to full recovery.

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