The Physiological Effects of Percutaneous Right Ventricular Assist Device

Purpose The dual lumen cannula connected to a centrifugal extracorporeal pump has been used as a percutaneous right ventricular assist device (RVAD) for RV failure. We describe the physiological changes and outcomes associated with this continuous-flow percutaneous RVAD. Methods We included 7 patients underwent percutaneous RVAD from September 2015-June 2018: post-LVAD (n=6), post-heart transplant (n=1), after excluding 2 patients converted from/to peripheral VA-ECMO and 2 with oxygenator use with the RVAD. Baseline and 3-hour post-insertion arterial blood gases, end-tidal carbon dioxide (ETCO2) and hemodynamic parameters were compared. There were no changes in ventilator parameters during this period of assessment. Results The median duration of support was 10 days (minimum 1 day, maximum 29 days). There were 2 deaths of the 7 patients at less than 90 days (both post-LVAD). Percutaneous RVAD resulted in a drop in central venous pressure (CVP 16.4±2.1 to 12.8±2.7mmHg, p=0.024) and blood pressure increase (64.5±4.1 to 75.1±9.9mmHg, p=0.030) with no significant change in inotropic/vasopressor use. There was a rise in arterial CO2 without significant changes in ETCO2, which resulted in an increase in the arterial-ETCO2 gradient [FIGURE]. The modest change in arterial pH (7.35±0.06 to 7.33±0.05, p=0.646) reflected the increase in arterial CO2, as there were reductions in base deficits (-4.5±2.9 to -2.7±1.7, p=0.259) and lactate levels (5.0±2.2 to 2.2±0.5IU, p=0.027). There was no significant change in oxygenation (PaO2 12.2±2.9 to 12.6±1.4kPa, p=0.838). None of the patients required extracorporeal CO2 removal. Conclusion Continuous flow percutaneous RVAD improves hemodynamics but transiently worsens the arterial-ETCO2 gradient without affecting oxygenation in some patients with RV failure.