Prolonged Use of Levitronix Right Ventricular Assist Device (RVAD) in Patients with Long Term Left Ventricular Assist Device (LVAD)
- #AC/END 01-O-4
- Adult Cardiac Surgery/End-stage Heart Failure/Heart Transplantation/VADs/ECMO. SESSION-1
- Oral
Prolonged Use of Levitronix Right Ventricular Assist Device (RVAD) in Patients with Long Term Left Ventricular Assist Device (LVAD)
Kamran Kerimzade 1, Syed Mohiyaddin 2, Nathan Tyson 1, Debamalaya Ray 1, Vincenzo Ciaci 1
1 Morriston Hospital, Swansea, United Kingdom; 2 Swansea University Medical School, Swansea, United Kingdom;
Date, time and location: 2018.05.27 10:30, Congress Hall, 2F–A
Abstract
Objective
Severe right
ventricular failure after implantation of long-term LVAD (LTLVAD) is common and
occasionally requires the need for right support. The choices for RVAD support
are limited mainly by short term devices.
METHODS
7 published papers were looked up
reviewing data including one with multicentre trial of patients who had
LTLVAD and required Centrimag RVAD implantation. There were 423 patients, 73
had Heartmate I, 20 Thoratec PVAD, 43 Jarvik 2000, 12 HeartWare and 275
HeartMate II. Mean age was 38.6 (range13-59) years. 73.9% were male, 21.7%
had ICM and 78,3% DCM. 64 had preoperative mechanical ventilation, 83 had IABP
and37%had multiple inotropic support. 36.5% patients
underwent early right VAD insertion (<24 hours) 26.1% delayed (>24hours)
while 17.24% were moribound patients salvaged with BiVAD
Centrimag as a bridge to decision and later on upgraded for a LTLVAD and
required continuous support of RVAD Centrimag.
RESULTS
Postoperative mean ventilation time 4.7days, ICU stay of 12.3days and
hospital stay was 22.8 days. Mean duration of LTLVAD and RVAD support was 212 (range 4-619 days) and 44 (range 6 to 207) days, respectively. Operative
mortality was 17.4%., 78.3%patients had
their RVAD explanted, 26.1% were bridged to transplant, 8.7% had full
myocardial recovery and had LTLVAD explanted. 74 patients are ongoing. There was
no incidence of pump failure or thrombosis. The vast majority of patients
were mobilised and exercised out of bed while on BIVAD support.
CONCLUSION
Prolonged use of RVAD Centrimag appears to be safe and effective for
recovery or bridge to transplantation in patients with severe right ventricular
failure and LTLVAD. Retrospectively it appears BiVAD devices could be used for
long term in patients waiting for a transplant beyond 6 months from analysing
these papers.