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Implantation of the Syncardia Total Artificial Heart

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Temporary Right Ventricular Support Using the Existing Bypass Circuit During LVAD Implantation.

Navin G Vigneshwar¹, Brandon M Wojcik¹, Leo V Carr²

¹Division of Cardiothoracic Surgery, University of Colorado, Aurora, Colorado.

Annals of Thoracic Surgery Short Reports

|January 10, 2025

Summary

A novel technique provides short-term right ventricular (RV) support during left ventricular assist device (LVAD) implantation. This method aids RV recovery in high-risk patients, improving outcomes after cardiopulmonary bypass (CPB).

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Area of Science:

Cardiovascular Surgery
Mechanical Circulatory Support
Heart Failure Management

Background:

Right-sided heart failure (RV failure) is a significant complication following left ventricular assist device (LVAD) implantation.
Developing strategies for expedient short-term right ventricular support during LVAD procedures is crucial.

Purpose of the Study:

To develop and evaluate a technique for immediate right ventricular (RV) support using the existing cardiopulmonary bypass (CPB) circuit during LVAD implantation.
To assess the efficacy of this modified CPB technique in high-risk patients prone to RV failure.

Main Methods:

A modified cardiopulmonary bypass (CPB) circuit was employed, incorporating four wye (Y) connections.
This modification allowed for the exclusion of the venous reservoir and oxygenator, enabling the flow of venous or arterialized blood through the same CPB outflow line.

Main Results:

Six high-risk patients for early RV failure underwent LVAD implantation using the modified CPB technique between 2019 and 2022.
All six patients were successfully weaned from CPB to LVAD support without requiring additional RV support post-procedure.

Conclusions:

The described technique offers a flexible approach to manage right ventricular failure during the critical post-CPB period in LVAD recipients.
This method facilitates intraoperative RV recovery and successful separation from CPB, enhancing patient outcomes.