Left ventricular unloading using a percutaneous paracorporeal
left ventricular assist device – University Hospital Centre Zagreb experience

    Authors

    Keywords

    cardiogenic shock, extracorporeal membrane oxygenation, ProtekSolo, left ventricular unloading

    DOI

    https://doi.org/10.15836/ccar2021.31

    Full Text

    Background : Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used in refractory cardiogenic shock and cardiac arrest but is characterized by increased left ventricular (LV) afterload and consequent development of pulmonary oedema (ECMO lungs). The ProtekSoloTM (LivaNova, IT) cannula is inserted via the right femoral vein to the left atrium, by a trans-septal puncture (under the guidance of transesophageal echocardiography and fluoroscopy). This bypasses the LV by draining blood from the left atrium to a paracorporeal pump (eg Rotaflow pump (Maquet, DE)) and returning it via a femoral artery cannula, thus providing direct unloading of LV. ( 1 - 3 ) We aimed to demonstrate our experience with the paracorporeal LV assist device using the ProtekSolo cannula and Rotaflow pump (PSp-LVAD). Patients and Methods : 7 adult patients underwent PSp-LVAD placement in UHC Zagreb from January to December 2020. We divided the patients in two groups: those who required PSp-LVAD to treat ECMO lungs (n=4) and those who received PSp-LVAD implantation prior to developing ECMO lungs (n=3). In addition to the description of the treated patients, we also assessed 30-day all-cause mortality. Results : The baseline characteristics of patients are shown in Table 1 . All patients were male, mean age 56±9.3 years. 57.1% of patients underwent PSp-LVAD placement due to worsening of chronic heart failure and 42.9% due to acute coronary syndrome. Concurrent infection was present in 57.1% of patients. 71.4% were first on VA-ECMO support, of those 80% developed ECMO lungs. Laboratory tests ( Figure 1 ) show improvement in kidney and liver function after PSp-LVAD placement. Outcomes are shown in Table 2 ; patients in prophylactic group have lower observed 30-day mortality rate (33% vs 75%) and longer VA-ECMO support duration due to lower mortality. Besides 2 patients who are still in active treatment, all others died during initial hospitalization due to infective complications, predominantly those that had a concurrent infection upon institution of the PSp-LVAD. Laboratory values before and after Protek Solo paracorporeal left ventricular assist device placement. BUN: blood urea nitrogen, NTproBNP: N-terminal prohormone of brain natriuretic peptide, AST: aspartate transaminase. Conclusion : Pulmonary edema (ECMO lungs) due to increased LV afterload is a major complication of VA-ECMO. Prophylactic LV unloading by PSp-LVAD seems associated with lower 30-days mortality.

    Cardiologia Croatica
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    Left ventricular unloading using a percutaneous paracorporeal
left ventricular assist device – University Hospital Centre Zagreb experience

    Extended Abstract
    Issue1-2
    Published
    Pages31-32
    PDF via DOIhttps://doi.org/10.15836/ccar2021.31
    cardiogenic shock
    extracorporeal membrane oxygenation
    ProtekSolo
    left ventricular unloading

    Authors

    Dubravka Šipuš*ORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Ivo PlanincORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Boško SkorićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Vedran VelagićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Marijan PašalićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Hrvoje JurinORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Daniel LovrićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Jure SamardžićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Jana Ljubas MačekORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Hrvoje GašparovićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Bojan BiočinaORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Davor MiličićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Maja ČikešORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia

    Full Text

    Background : Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used in refractory cardiogenic shock and cardiac arrest but is characterized by increased left ventricular (LV) afterload and consequent development of pulmonary oedema (ECMO lungs). The ProtekSoloTM (LivaNova, IT) cannula is inserted via the right femoral vein to the left atrium, by a trans-septal puncture (under the guidance of transesophageal echocardiography and fluoroscopy). This bypasses the LV by draining blood from the left atrium to a paracorporeal pump (eg Rotaflow pump (Maquet, DE)) and returning it via a femoral artery cannula, thus providing direct unloading of LV. ( 1 - 3 ) We aimed to demonstrate our experience with the paracorporeal LV assist device using the ProtekSolo cannula and Rotaflow pump (PSp-LVAD). Patients and Methods : 7 adult patients underwent PSp-LVAD placement in UHC Zagreb from January to December 2020. We divided the patients in two groups: those who required PSp-LVAD to treat ECMO lungs (n=4) and those who received PSp-LVAD implantation prior to developing ECMO lungs (n=3). In addition to the description of the treated patients, we also assessed 30-day all-cause mortality. Results : The baseline characteristics of patients are shown in Table 1 . All patients were male, mean age 56±9.3 years. 57.1% of patients underwent PSp-LVAD placement due to worsening of chronic heart failure and 42.9% due to acute coronary syndrome. Concurrent infection was present in 57.1% of patients. 71.4% were first on VA-ECMO support, of those 80% developed ECMO lungs. Laboratory tests ( Figure 1 ) show improvement in kidney and liver function after PSp-LVAD placement. Outcomes are shown in Table 2 ; patients in prophylactic group have lower observed 30-day mortality rate (33% vs 75%) and longer VA-ECMO support duration due to lower mortality. Besides 2 patients who are still in active treatment, all others died during initial hospitalization due to infective complications, predominantly those that had a concurrent infection upon institution of the PSp-LVAD. Laboratory values before and after Protek Solo paracorporeal left ventricular assist device placement. BUN: blood urea nitrogen, NTproBNP: N-terminal prohormone of brain natriuretic peptide, AST: aspartate transaminase. Conclusion : Pulmonary edema (ECMO lungs) due to increased LV afterload is a major complication of VA-ECMO. Prophylactic LV unloading by PSp-LVAD seems associated with lower 30-days mortality.