ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Reiner Körfer
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Minami, K.
Right arrow Articles by Körfer, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Minami, K.
Right arrow Articles by Körfer, R.

Ann Thorac Surg 1999;68:1092-1093
© 1999 The Society of Thoracic Surgeons

How To Do It

New technique for the outflow cannulation of right ventricular assist device

Kazutomo Minami, MD, PhDa, Yukihiro Bonkohara, MDa, Latif Arusoglu, MDa, Aly El-Banayosy, MDa, Reiner Körfer, MD, PhDa

a Department of Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, University of Bochum, Bad Oeynhausen, Germany

Address reprint requests to Dr Minami, Herzzentrum NRW, Georgstr 11, 32545, Bad Oeynhausen, Germany


   Abstract
Top
 Abstract
Introduction
 Technique
 Comment
 References
 
Cannulating the outflow cannula of a right ventricular assist device (RVAD) through the main pulmonary artery is often troublesome because of extensive dissecting adhesion. We implanted RVADs using the new technique for outflow cannulating through the right pulmonary artery between the ascending aorta and the superior vena cava. With this technique, we needed only a little dissection and no cardiopulmonary bypass. This technique could make RVAD implantation simple, quick, and safe.


   Introduction
Top
 Abstract
 Introduction
Technique
 Comment
 References
 
Patients with severe right heart failure, especially after left ventricular assist device (LVAD) implantation, heart transplantation, or postcardiotomy shock, for which no other therapies, such as catecholamines, phosphodiesterase III inhibitors, or nitric oxide are effective, need right ventricular assist device (RVAD) implantations. Most of these patients already have serious complications, such as bleeding, coagulopathy, pulmonary hypertension, or liver failure. Therefore it is very important to implant RVAD as noninvasively as possible. For this reason, it is favorable to implant it without extensive dissection and cardiopulmonary bypass (CPB). We performed right ventricular support with this method in 3 patients: 1 after redo coronary artery bypass grafting, 1 after heart transplantation, and 1 after LVAD implantation. All cases needed only a little dissection and no CPBs, and could be weaned from the devices successfully.


   Technique
Top
 Abstract
 Introduction
 Technique
Comment
 References
 
The inflow cannula (Stöckert GmbH, München, Germany) is inserted through the right atrium appendage with the double pursestring sutures as usual, and then the outflow cannula (Biomedicus, Medtronic, Minneapolis, MN) is inserted through the right pulmonary artery between the ascending aorta and the superior vena cava using the Seldinger method, and the top of cannula placed in the main pulmonary artery (Fig 1). This outflow cannula is also fixed with double pursestring sutures. With this cannula, we could also obtain enough output (Table 1). After the recovery of right ventricular function, the cannulas can be extracted by simply closing the pursestring sutures.



View larger version (50K):
[in this window]
[in a new window]
  		Fig 1. Illustration of the cannulation technique for the right ventricular assist device: The inflow cannula is inserted through the right atrial appendage and the outflow cannula through the right pulmonary artery.

 

View this table:
[in this window]
[in a new window]
  		Table 1. Right Ventricular Support With Biomedicus Centrifugal Pump

 

   Comment
Top
 Abstract
 Introduction
 Technique
 Comment
References
 
From September 1987, we used various mechanical circulatory support systems, such as the Biomedicus centrifugal pump (Biomedicus, Medtronic, Minneapolis, MN), the ABIOMED BVS System (ABIOMED, Danvers, MA), the Thoratec ventricular assist device (Thoratec, Berkeley, CA), and Novacor left ventricular assist device (Novacor Division, Baxter Healthcare Corp, Oakland, CA) [1, 2]. With RVAD implantation, we were routinly cannulating the inflow cannula through the right atrium appendage, and the outflow cannula through the main pulmonary artery. However, cannulating through the main pulmonary artery frequently required extensive dissection and CPB. Most of the patients who needRVAD implantations have already undergone other operations, such as LVAD implantation, heart transplantation, and other open heart surgical procedures. The report from the Pittsburgh group showed that 25% of LVAD implanted patients suffered from severe right heart failure requiring additional extended inotropic supports or mechanical supports [3]. In our series in Bad Oeynhausen, 9 of 110 patients who underwent mechanical left-ventricular support by implantable assist devices (Novacor or HeartMate, Thermo Cardiosystems Inc, Woburn, MA) suffered from right ventricular failure postoperatively and were treated by additional RVAD. Five of them (55.6%) could not be weaned from RVAD or died within 30 postoperative days due to profound right ventricular dysfunction, severe bleeding, or sepsis. Postoperative bleeding is one of the most frequent complications after RVAD implantation [4, 5], which needs rethoracotomy, leads to sepsis, and finally to critical situations like multiple organ failure. With this new approach though the right pulmonary artery, which does not need extensive dissection and CPB, the risk of postoperative bleeding can be minimized. In addition, the risk of severe right heart failure resulting from rising of pulmonary vascular resistance, which is caused by activated chemical mediator using CPB [6], can be also avoided. For these reasons, we consider this new technique for outflow cannulation of RVAD simple, quick, and safe.


   References
Top
 Abstract
 Introduction
 Technique
 Comment
 References
 

  1. Körfer R., El-Banayosy A., Posival H., et al. Mechanical circulatory support. Ann Thorac Surg 1995;59:S56-S63.
  2. Minami K., Arusoglu A., El-Banayosy A., et al. Bridging for heart transplantation by different types of ventricular assist device. In: Akutsu T., Koyanagi H., eds. Heart replacement—artificial heart 6. Tokyo: Springer, 1998:81-90.
  3. Kawai A., Kormos R.L., Morita S., et al. Quantitative detection of regional right ventricular contraction abnormalities during left ventricular assistance. In: Akutsu T., Koyanagi H., eds. Heart replacement—artificial heart 4. Tokyo: Springer, 1993:253-258.
  4. Barnard S.P., Hansen A., Forty J., Hilton C.J., Dark J.H. Mechanical ventricular assistance for the failing right ventricle after cardiac transplantation. Eur J Cardiothorac Surg 1995;9:297-299.[Abstract]
  5. Chen J.M., Levin H.R., Rose E.A., et al. Experience with right ventricular assist devices for perioperative right-sided circularoty failure. Ann Thorac Surg 1996;61:305-310.[Abstract/Free Full Text]
  6. Kormos R.L., Gasior T.A., Kawai A., et al. Transplant candidate’s clinical status rather than right ventricular function defines need for univentricular versus biventricular support. J Thorac Cardiovasc Surg 1996;111:773-783.[Abstract/Free Full Text]
Accepted for publication May 24, 1999.




This article has been cited by other articles:


Home page
 Anesth. Analg.Home page
S. Chumnanvej, M. J. Wood, T. E. MacGillivray, and M. F. V. Melo
Perioperative Echocardiographic Examination for Ventricular Assist Device Implantation
Anesth. Analg., September 1, 2007; 105(3): 583 - 601.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
V. Rao, M. C. Oz, N. M. Edwards, and Y. Naka
A new off-pump technique for thoratec right ventricular assist device insertion
Ann. Thorac. Surg., May 1, 2001; 71(5): 1719 - 1720.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Reiner Körfer
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Minami, K.
Right arrow Articles by Körfer, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Minami, K.
Right arrow Articles by Körfer, R.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS