Deployment, Configuration and Complications of Percutaneous Right Ventricular Assist Device - The Birmingham Experience.

To describe our experience with percutaneous right ventricular assist device (RVAD) as part of temporary mechanical circulatory support (tMCS) strategy. Prospectively data from 2017-21. Indications: (i) post-LVAD, (ii) post-heart transplant, and (iii) miscellaneous indications. Deployment: primary tMCS or as planned staged weaning from VA-ECMO. Staged weaning was considered to minimise ECMO run in isolated RV failure. Configurations : (i) single dual lumen cannula (RVAD1) or (ii) two single lumen cannula (RVAD2). Centrifugal flow pump was used in both configurations. 2-single lumen cannula was preferred if >3.5L/min is anticipated. An oxygenator may be added for respiratory support. Complications : displacement, SVC obstruction and hemolysis were recorded. 44 patients received 49 RVADs over 45 separate in-patient episodes. 12 patients died within 90 days (27%). By indications : 1/13 (8%) death in heart transplant, 6/20 (28%) in post-LVAD and 5/11 (45%) in the miscellaneous group [ Figure ]. By deployment : As primary tMCS, RVAD was used in isolation in 18 patients and in combination with Impella in 2 patients. 2/20 (10%) staged ECMO weaning vs 10/24 (41%) of primary treatment died <90 days. Both RVAD+Impella patients died <90 days. Configuration : RVAD1 in 32 patients, RVAD2 in 12 patients. Oxygenator was added in 10 RVAD1 for 7 (5-12) days and 4 RVAD2 for 6 (2-15) days, p=0.768. Lactate 24-hours post-RVAD was lower in RVAD2 compared to RVAD1: 1.21 (0.91-1.39) vs 1.45 (1.14-1.77)mmol/l, p=0.024. Complications : There were 2 displacements (1 death), 2 hemolysis and 2 SVC obstruction in RVAD1 but none in RVAD2. SVC obstruction resolved after conversion to RVAD2. 1. Survival with RVAD is highest in post-LVAD or transplant, especially as planned staged VA ECMO weaning. 2. Outcomes are poor as primary tMCS (+/-Impella) in cardiogenic shock. 3. RVAD2 may have lower complication rates and better lactate clearance than RVAD1. [ABSTRACT FROM AUTHOR]