Different ECLS Pump Configurations for Temporary Right Ventricular Assist Device in LVAD Patients: A Retrospective...

Area of Science:

• Cardiovascular Surgery
• Mechanical Circulatory Support
• Critical Care Medicine

Background:

• Acute right ventricular failure is a significant complication following left ventricular assist device (LVAD) implantation.
• Temporary paracorporeal right ventricular assist devices (RVADs) are commonly used for management.
• Different extracorporeal life support (ECLS) systems may impact patient outcomes.

Purpose of the Study:

• To compare the outcomes of three temporary RVAD systems: Centrimag™, Cardiohelp™, and Deltastream™.
• To evaluate mortality, bleeding complications, and intensive care unit (ICU) stay duration.
• To identify potential differences in system performance and patient impact.

Main Methods:

• A monocentric, retrospective case-control study included 245 patients who received LVAD with paracorporeal RVAD between 2009 and 2020.
• Patients were divided into three groups based on the RVAD system used: Centrimag™ (A), Cardiohelp™ (B), and Deltastream™ (C).
• Outcomes assessed included in-hospital mortality, reoperation rates due to bleeding, and ICU length of stay.

Main Results:

• While preoperative INTERMACS scores were similar between Centrimag™ and Deltastream™ groups, Cardiohelp™ patients had worse scores.
• In-hospital death rates were 41.8% (A), 32.6% (B), and 54.7% (C).
• Reoperation rates due to bleeding were significantly higher in the Deltastream™ group (47.2%) compared to Centrimag™ (21.9%) and Cardiohelp™ (17.4%), with increased thrombocyte consumption and prolonged ICU stays.

Conclusions:

• Temporary RVADs are associated with bleeding complications that affect patient outcomes.
• The Deltastream™ system demonstrated a significantly higher incidence of bleeding complications, potentially linked to high pump speeds and reduced thrombocyte counts.
• Further prospective studies are recommended to validate these findings due to the retrospective nature and patient complexity.