332 * MINIMALLY INVASIVE RIGHT VENTRICULAR ASSIST DEVICE IMPLANTATION TECHNIQUE IMPROVES THE OUTCOME OF PATIENTS WITH PERIOPERATIVE RIGHT VENTRICULAR FAILURE

Abstract

Objectives: Temporary right ventricular assist device (RVAD) support may be required for patients with perioperative refractory right ventricular failure (RVF). We report our experience with a minimally invasive RVAD implantation technique, that does not necessitate resternotomy at the time of RVAD removal. Methods: Patients with acute postoperative RVF who underwent temporary RVAD implantation between January 2010 and March 2013 were reviewed. A Dacron graft was attached to the pulmonary artery and passed through a subxiphoid exit, where the RVAD outflow cannula was inserted. The inflow cannula was percutaneously inserted in the femoral vein. The sternum was closed primarily in all patients. Results: Seventeen patients (age 57 +/- 15 years) were supported. Thirteen patients (76%) had RVF following LVAD implantation and four patients developed postcardiotomy RVF (two after coronary artery bypass graft surgery, and two following aortic valve replacement). The average duration of RVAD support was 17 +/- 21 (range 4-88) days. In 10 patients (63%), the RVAD was successfully removed; two patients were bridged to transplantion; four patients expired on LVAD/RVAD support; the remaining patient is still ongoing. On the day of RVAD explantation, the outflow graft of the RVAD was carefully pulled, ligated, and the insertion site was secondarily closed. The RVAD inflow cannula was removed and direct pressure was applied. The in-hospital mortality was 24%. Conclusions: This is the largest published report on minimally invasive RVAD implantation using the above described technique for various forms of postoperative RVF. No technical issues were encountered. Early extubation and mobilization, extended support duration, and reducing resternotomy risks may explain the better outcome compared with conventional RVAD implantation methods.