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TandemHeart: perkutanes rechtsventrikuläres Assist Device

  • Anja OßwaldEmail author
  • Arjang Ruhparwar
  • Bastian Schmack
Chapter
  • 189 Downloads

Zusammenfassung

Das akute Rechtsherzversagen ist mit einer hohen Mortalität verbunden. Das TandemHeart ist eine extrakorporale Zentrifugalpumpe, die zur rechts-, links- und biventrikulären mechanischen Unterstützung zugelassen ist. Im Falle der Rechtsherzinsuffizienz wird der rechte Ventrikel umgangen, indem das Blut über eine perkutane Duallumenkanüle (ProtekDuo) aus dem rechten Vorhof drainiert und in Verbindung mit dem TandemHeart aktiv in die Pulmonalaterie gepumpt wird. Die Implantation der ProtekDuo-Kanüle wird mittels minimalinvasivem Zugang in Seldinger-Technik über die rechtsseitige Vena jugularis interna durchgeführt und erlaubt eine vollständige Mobilisation durch Vermeidung eines Leistengefäßzuganges. Die Indikationen umfassen das akute Rechtsherzversagen im kardiogenen Schock, nach Rechtsherzinfarkt, im Rahmen einer LVAD-Implantation bei bestehender rechtsventrikulärer Insuffizienz bei Lungenarterienembolie sowie im perioperativen Umfeld von Hochrisikotrikuspidalklappenoperationen. Ziel der Unterstützung ist die temporäre Entlastung des rechten Ventrikels, eine ausreichende venöse Drainage und das Aufrechterhalten eines suffizienten pulmonalarterien Blutflusses, wodurch eine unmittelbare Stabilisierung der Kreislaufsituation im akuten Rechtsherzversagen gelingt.

Literatur

  1. Allender JE, Reed BN, Foster JL, Moretz JD, Oliphant CS, Jennings DL, Didomenico RJ, Coons JC (2017) Pharmacologic considerations in the management of patients receiving left ventricular percutaneous mechanical circulatory support. Pharmacotherapy 37:1272–1283CrossRefGoogle Scholar
  2. Anderson M, Morris DL, Tang D, Batsides G, Kirtane A, Hanson I, Meraj P, Kapur NK, O’Neill W (2018) Outcomes of patients with right ventricular failure requiring short-term hemodynamic support with the Impella RP device. J Heart Lung Transplant 37:1448–1458CrossRefGoogle Scholar
  3. Atluri P, Goldstone AB, Fairman AS, Macarthur JW, Shudo Y, Cohen JE, Acker AL, Hiesinger W, Howard JL, Acker MA, Woo YJ (2013) Predicting right ventricular failure in the modern, continuous flow left ventricular assist device era. Ann Thorac Surg 96:857–863; discussion 863–864.CrossRefGoogle Scholar
  4. Bellavia D, Iacovoni A, Scardulla C, Moja L, Pilato M, Kushwaha SS, Senni M, Clemenza F, Agnese V, Falletta C, Romano G, Maalouf J, Dandel M (2017) Prediction of right ventricular failure after ventricular assist device implant: systematic review and meta-analysis of observational studies. Eur J Heart Fail 19:926–946CrossRefGoogle Scholar
  5. Boeken U, Feindt P, Litmathe J, Kurt M, Gams E (2009) Intraaortic balloon pumping in patients with right ventricular insufficiency after cardiac surgery: parameters to predict failure of IABP Support. Thorac Cardiovasc Surg 57:324–328CrossRefGoogle Scholar
  6. Dandel M, Hetzer R (2018) Temporary assist device support for the right ventricle: pre-implant and post-implant challenges. Heart Fail Rev 23:157–171CrossRefGoogle Scholar
  7. Dandel M, Krabatsch T, Falk V (2015) Left ventricular vs. biventricular mechanical support: decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation. Int J Cardiol 198:241–250CrossRefGoogle Scholar
  8. Fitzpatrick JR, 3rd, Frederick JR, Hiesinger W, Hsu VM, Mccormick RC, Kozin ED, Laporte CM, O’hara ML, Howell E, Dougherty D, Cohen JE, Southerland KW, Howard JL, Paulson EC, Acker MA, Morris RJ, Woo YJ (2009) Early planned institution of biventricular mechanical circulatory support results in improved outcomes compared with delayed conversion of a left ventricular assist device to a biventricular assist device. J Thorac Cardiovasc Surg 137:971–977CrossRefGoogle Scholar
  9. Giesler GM, Gomez JS, Letsou G, Vooletich M, Smalling RW (2006) Initial report of percutaneous right ventricular assist for right ventricular shock secondary to right ventricular infarction. Catheter Cardiovasc Interv 68:263–266CrossRefGoogle Scholar
  10. Gilotra NA, Stevens GR (2014) Temporary mechanical circulatory support: a review of the options, indications, and outcomes. Clin Med Insights Cardiol 8:75–85PubMedGoogle Scholar
  11. Gomez-Abraham J, Brann S, Aggarwal V, O’Neill B, Alvarez R, Hamad E, Toyoda Y (2018) Use of Protek Duo Cannula (RVAD) for percutaneous support in various clinical settings. A safe and effective option. The J Heart Lung Transplant 37:102CrossRefGoogle Scholar
  12. Gomez-Abraham J, Brann S, Aggarwal V, O’neill B, Alvarez R, Hamad E, Toyoda Y (2018b) Use of Protek Duo Cannula (RVAD) for percutaneous support in various clinical settings. A safe and effective option. J Heart Lung Transplant 37:102CrossRefGoogle Scholar
  13. Kalogeropoulos AP, Kelkar A, Weinberger JF, Morris AA, Georgiopoulou VV, Markham DW, Butler J, Vega JD, Smith AL (2015) Validation of clinical scores for right ventricular failure prediction after implantation of continuous-flow left ventricular assist devices. J Heart Lung Transplant 34:1595–1603CrossRefGoogle Scholar
  14. Kapur NK, Esposito ML, Bader Y, Morine KJ, Kiernan MS, Pham DT, Burkhoff D (2017) Mechanical circulatory support devices for acute right ventricular failure. Circulation 136:314–326CrossRefGoogle Scholar
  15. Kapur NK, Paruchuri V, Jagannathan A, Steinberg D, Chakrabarti AK, Pinto D, Aghili N, Najjar S, Finley J, Orr NM, Tempelhof M, Mudd JO, Kiernan MS, Pham DT, Denofrio D (2013) Mechanical circulatory support for right ventricular failure. JACC Heart Fail 1:127–134CrossRefGoogle Scholar
  16. Kapur NK, Paruchuri V, Korabathina R, Al-Mohammdi R, Mudd JO, Prutkin J, Esposito M, Shah A, Kiernan MS, Sech C, Pham DT, Konstam MA, Denofrio D (2011) Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure. J Heart Lung Transplant 30:1360–1367CrossRefGoogle Scholar
  17. Klima U, Ringes-Lichtenberg S, Warnecke G, Lichtenberg A, Struber M, Haverich A (2005) Severe right heart failure after heart transplantation. A single-center experience. Transpl Int 18:326–332CrossRefGoogle Scholar
  18. Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, Kociol RD, Lewis EF, Mehra MR, Pagani FD, Raval AN, Ward C, American Heart Association Council On Clinical C, Council On Cardiovascular Disease In The Y, Council On Cardiovascular S, Anesthesia (2018) Evaluation and management of right-sided heart failure: a scientific statement from the American heart association. Circulation 137:e578-e622Google Scholar
  19. Kormos RL, Teuteberg JJ, Pagani FD, Russell SD, John R, Miller LW, Massey T, Milano CA, Moazami N, Sundareswaran KS, Farrar DJ, Heartmate IICI (2010) Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg 139:1316–1324CrossRefGoogle Scholar
  20. Lampert BC, Teuteberg JJ (2015) Right ventricular failure after left ventricular assist devices. J Heart Lung Transplant 34:1123–1130CrossRefGoogle Scholar
  21. Lin W, Poh AL, Tang WHW (2018) Novel insights and treatment strategies for right heart failure. Curr Heart Fail Rep 15:141–155CrossRefGoogle Scholar
  22. Matthews JC, Koelling TM, Pagani FD, Aaronson KD (2008) The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates. J Am Coll Cardiol 51:2163–2172CrossRefGoogle Scholar
  23. Mihaljevic T, Jarrett CM, Gonzalez-Stawinski G, Smedira NG, Nowicki ER, Thuita L, Mountis M, Blackstone EH (2012) Mechanical circulatory support after heart transplantation. Eur J Cardiothorac Surg 41:200–216; discussion 206.Google Scholar
  24. Morgan JA, Paone G, Nemeh HW, Murthy R, Williams CT, Lanfear DE, Tita C, Brewer RJ (2013) Impact of continuous-flow left ventricular assist device support on right ventricular function. J Heart Lung Transplant 32:398–403CrossRefGoogle Scholar
  25. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Group, ESCSD (2016) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200CrossRefGoogle Scholar
  26. Riebandt J, Haberl T, Wiedemann D, Moayedifar R, Schloeglhofer T, Mahr S, Dimitrov K, Angleitner P, Laufer G, Zimpfer D (2018) Extracorporeal membrane oxygenation support for right ventricular failure after left ventricular assist device implantation. Eur J Cardiothorac Surg 53:590–595CrossRefGoogle Scholar
  27. Saeed D, Maxhera B, Kamiya H, Lichtenberg A, Albert A (2015) Alternative right ventricular assist device implantation technique for patients with perioperative right ventricular failure. J Thorac Cardiovasc Surg 149:927–932CrossRefGoogle Scholar
  28. Saffarzadeh A, Bonde P (2015) Options for temporary mechanical circulatory support. J Thorac Dis 7:2102–2111PubMedPubMedCentralGoogle Scholar
  29. Schmack B, Farag M, Kremer J, Grossekettler L, Brcic A, Raake PW, Kreusser MM, Goldwasser R, Popov AF, Mansur A, Karck M, Ruhparwar A (2019) Results of concomitant groin-free percutaneus temporary RVAD support using a centrifugal pump with a double-lumen jugular venous cannula in LVAD patients. J Thorac Dis 11(6):S913–S920. https://doi.org/10.21037/jtd.2018.11.121CrossRefGoogle Scholar
  30. Schmack B, Weymann A, Popov AF, Patil NP, Sabashnikov A, Kremer J, Farag M, Brcic A, Lichtenstern C, Karck M, Ruhparwar A (2016) Concurrent Left Ventricular Assist Device (LVAD) Implantation and Percutaneous Temporary RVAD Support via CardiacAssist Protek-Duo TandemHeart to Preempt Right Heart Failure. Med Sci Monit Basic Res 22:53–57CrossRefGoogle Scholar
  31. Schopka S, Haneya A, Rupprecht L, Camboni D, Schmid C, Hilker M (2012) Temporary right heart assist: a minimally invasive approach. Artif Organs 36:700–704CrossRefGoogle Scholar
  32. Shehab S, Allida SM, Davidson PM, Newton PJ, Robson D, Jansz PC, Hayward CS (2017) Right Ventricular Failure Post LVAD Implantation Corrected with Biventricular Support: An In Vitro Model. ASAIO J 63:41–47CrossRefGoogle Scholar
  33. Stevenson LW, Pagani FD, Young JB, Jessup M, Miller L, Kormos RL, Naftel DC, Ulisney K, Desvigne-Nickens P, Kirklin JK (2009) INTERMACS profiles of advanced heart failure: the current picture. J Heart Lung Transplant 28:535–541CrossRefGoogle Scholar
  34. Webb DP, Warhoover MT, Eagle SS, Greelish JP, Zhao DX, Byrne JG (2008) Argatroban in short-term percutaneous ventricular assist subsequent to heparin-induced thrombocytopenia. J Extra Corpor Technol 40:130–134PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2020

Authors and Affiliations

  • Anja Oßwald
    • 1
    Email author
  • Arjang Ruhparwar
    • 1
  • Bastian Schmack
    • 2
  1. 1.Thorax- und Kardiovaskuläre ChirurgieUniversitätsklinikum Essen, Westdeutsches Herz- und Gefäßzentrum Essen, Klinik für Thorax- und Kardiovaskuläre ChirurgieEssenDeutschland
  2. 2.HerzchirurgieUniversitätsklinikum HeidelbergHeidelbergDeutschland

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