A Dual-Lumen Percutaneous Cannula for Managing Refractory Right Ventricular Failure
A Dual-Lumen Percutaneous Cannula for Managing Refractory Right Ventricular Failure
复制标题
DOI：
10.1097/mat.0000000000001099
复制
发表时间：
2020-08-01
期刊：
影响因子：
4.2
通讯作者：
Joyce, David L.
中科院分区：
文献类型：
--
作者：
Badu, Bernice;Cain, Michael T.;Joyce, David L.
使用经右颈内静脉（IJV）插入的双腔经皮插管的右心室辅助装置（RVAD）可能会改善难治性右心室（RV）衰竭患者的脱机。然而，报告的该套管经验有限。我们审查了2017年4月至2019年2月期间在我们机构使用这种新型双腔插管接受RVAD支持的所有患者的记录。我们记录了有关脱机、死亡率和器械特定并发症的数据。我们根据RVAD支持的适应症（心切开术后、心源性休克和原发性呼吸衰竭）比较了三个亚组的结局，并与文献中的类似结果进行了比较。40例患者（29例男性）的平均（标准差[SD]）年龄为53（15.5）岁。植入适应症为18例患者的心切开术后支持，12例心源性休克，10例呼吸衰竭。总之，心切开术后组中有17例（94%）患者脱离RVAD支持，心源性休克组中有5例（42%）患者脱离RVAD支持，呼吸衰竭组中有7例（70%）患者脱离RVAD支持，总体上高于文献报道的手术置入RVAD的患者（49%至59%）。尽管已发表的手术置入RVAD的住院死亡率范围为42%至50%，经右IJV植入经皮插管的RVAD的住院死亡率范围为41%至50%，但我们的亚组的死亡率分别为11%、58%和40%。无重大器械相关并发症。这种经皮双腔插管似乎可安全有效地治疗难治性RV衰竭，脱机和死亡率有所改善，器械特异性不良事件有限。
A right ventricular assist device (RVAD) using a dual-lumen percutaneous cannula inserted through the right internal jugular vein (IJV) might improve weaning in patients with refractory right ventricular (RV) failure. However, the reported experience with this cannula is limited. We reviewed the records of all patients receiving RVAD support with this new dual-lumen cannula at our institution between April 2017 and February 2019. We recorded data on weaning, mortality, and device-specific complications. We compared outcomes among three subgroups based on the indications for RVAD support (postcardiotomy, cardiogenic shock, and primary respiratory failure) and against similar results in the literature. Mean (standard deviation [SD]) age of the 40 patients (29 men) was 53 (15.5) years. Indications for implantation were postcardiotomy support in 18 patients, cardiogenic shock in 12, and respiratory failure in 10. In all, 17 (94%) patients in the postcardiotomy group were weaned from RVAD support, five (42%) in the cardiogenic shock group, and seven (70%) in the respiratory failure group, overall higher than those reported in the literature (49% to 59%) for surgically placed RVADs. Whereas published in-hospital mortality rates range from 42% to 50% for surgically placed RVADs and from 41% to 50% for RVADs with percutaneous cannulas implanted through the right IJV, mortality was 11%, 58%, and 40% in our subgroups, respectively. There were no major device-related complications. This percutaneous dual-lumen cannula appears to be safe and effective for managing refractory RV failure, with improved weaning and mortality profile, and with limited device-specific adverse events.