title: Temporary right ventricular support following left ventricle assist device implantation: a comparison of two techniques.
abstract: OBJECTIVE
  Right ventricular failure (RVF) after implantation of left ventricular assist device (LVAD) is a dramatic complication. We compared retrospectively two techniques of temporary right ventricular support after LVAD (HeartMate II, Thoratec Corp, Pleasonton, CA, USA) implantation.
  
  
  METHODS
  From 1 January 2006 to 31 December 2012, 78 patients [mean age 52 ± 1.34 years; 15 women (19%)] received a HeartMate II at our institution. Among these, 18 patients (23%) suffered postimplant RVF treated by peripheral temporary right ventricular support. Aetiology of heart failure was ischaemic in 12 (67%) and dilated cardiomyopathy in 6 (33%) patients. The preimplant RV risk score averaged 5.1 ± 0.59. Ten patients were treated using a femorofemoral venoarterial extracorporeal life support (ECLS) and 8 patients were treated using extracorporeal membrane oxygenation as a right ventricular assist device (RVAD) established between a femoral vein and the pulmonary artery via a Dacron prosthesis (RVAD).
  
  
  RESULTS
  Duration of RV support was 7.12 ± 5.4 days and 9.57 ± 3.5 days in venoarterial ECLS and vein and the pulmonary artery RVAD groups, respectively (P = 0.32). Three patients (17%) died while under RV support (venoarterial ECLS, n = 2; and vein and the pulmonary artery RVAD, n = 1, P = 0.58). In the venoarterial ECLS group, 6 (60%) patients suffered major thromboembolic complications including thrombosis of the ECLS arterial line (n = 2), ischaemic stroke (n = 2) and thrombosis of the ascending aorta (n = 2). No major complication was observed in the vein and the pulmonary artery RVAD group (P = 0.01). RV support was successfully weaned in 8 (80%) patients of the venoarterial ECLS group and in 7 (87.5%) of the vein and the pulmonary artery RVAD group (P = 0.58). The duration of postimplant intensive care unit stay was not different (respectively, 27.5 ± 18.7 days and 20.0 ± 12.0 days; P = 0.38) between both groups.
  
  
  CONCLUSIONS
  Temporary support of the failing RV after LVAD implantation using temporary vein and the pulmonary artery RVAD is a promising therapeutic option. This approach provides adequate LVAD pre- and afterload and is associated with significantly less thromboembolic complications.
authors.affiliation: Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital, University of Paris VI, Paris, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Noly
authors.affiliation: Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital, University of Paris VI, Paris, France matthias.kirsch@bch.aphp.fr.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kirsch
authors.affiliation: Department of Cardiac Anesthesia and Reanimation, Cardiology Institute, Pitié Salpêtrière Hospital, University of Paris VI, Paris, France.
authors.forename: Astrid
authors.initials: A
authors.lastname: Quessard
authors.affiliation: Department of Cardiac Anesthesia and Reanimation, Cardiology Institute, Pitié Salpêtrière Hospital, University of Paris VI, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Leger
authors.affiliation: Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital, University of Paris VI, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.affiliation: Department of Cardiac Anesthesia and Reanimation, Cardiology Institute, Pitié Salpêtrière Hospital, University of Paris VI, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Amour
authors.affiliation: Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital, University of Paris VI, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
mesh_terms: D000328:Adult; D000368:Aged; D017548:Echocardiography, Transesophageal; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005268:Femoral Vein / Q000503:physiopathology / Q000601:surgery; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: Extracorporeal membrane oxygenation; Left ventricular assistance device; Right ventricular failure