title: Temporary percutaneous right ventricular support using a centrifugal pump in patients with postoperative acute refractory right ventricular failure after left ventricular assist device implantation.
abstract: OBJECTIVE
  Acute right ventricular (RV) failure is a life-threatening condition with a poor prognosis, and sometimes the use of mechanical circulatory support is inevitable. In this article, we describe our experience using a centrifugal pump as a temporary percutaneous right ventricular assist device (RVAD) in patients with postoperative acute refractory RV failure after left ventricular assist device (LVAD) implantation.
  
  
  METHODS
  We retrospectively reviewed eight consecutive patients with acute RV failure who underwent temporary percutaneous RVAD implantation using a centrifugal pump after LVAD implantation between April 2008 and February 2011. A Dacron graft was attached to the main pulmonary artery and passed through a subxiphoid exit, where the outflow cannula was inserted. The inflow cannula was percutaneously cannulated using Seldinger's technique in the femoral vein. The chest was definitely closed. The technique allowed bedside removal, avoiding chest re-opening.
  
  
  RESULTS
  The median patient age was 52 years (range: 41-58). The median duration of support was 14 days (range: 12-14). RV systolic function improved; central venous pressure and mean pulmonary artery pressure decreased significantly after RVAD support. In three patients, an oxygenator was integrated into the RVAD due to impaired pulmonary function. Six patients were successfully weaned. Five patients survived to hospital discharge. Technical problems or serious complications concerning decannulation were not observed.
  
  
  CONCLUSIONS
  This report suggests that implantation of temporary percutaneous RVAD using a centrifugal pump is a safe alternative in the treatment of postoperative acute refractory RV failure. Ease of device implantation, weaning, explantation, and limited number of complications justify a liberal use.
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany. assadhaneya@web.de
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.forename: Thomas
authors.initials: T
authors.lastname: Puehler
authors.forename: Leopold
authors.initials: L
authors.lastname: Rupprecht
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kobuch
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Stephan W
authors.initials: SW
authors.lastname: Hirt
mesh_terms: D000208:Acute Disease; D000328:Adult; D002498:Centrifugation; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*