Centrifugal Pump Feasible Treatment for Refractory RV Failure

MIAMI BEACH, FLA.—Use of a centrifugal pump for the treatment of medically refractory right ventricular (RV) failure seems clinically feasible and is associated with improved hemodynamics in patients undergoing the procedure, according to data presented at TCT 2012.

Navin K. Kapur, MD, of Tufts Medical Center, Boston, Mass., and colleagues examined outcomes from 46 patients with RV failure who had undergone treatment with a centrifugal flow pump (TandemHeart, CardiacAssist). All data were retrospectively collected in the THRIVE registry, a large multicenter analysis of the TandemHeart device at eight U.S. centers. The device was deployed via percutaneous (48%) and surgical routes (52%).

In-hospital mortality risks

No intraprocedural mortality occurred among the patients. The rate of in-hospital mortality was 52.5% and was lowest among patients with acute inferior wall MI (33%). The most common complication associated with the device was TIMI major bleeding, which occurred in 42% of patients.

The data indicated that within 48 hours of the procedure, use of a centrifugal-flow pump was associated with improvement in RV function across a broad variety of hemodynamic measures (see Table).

The mean duration of device use was 5.4 days. During that time, percutaneous device flow rates averaged 4.2 L/min. According to the researchers, the device augmented native cardiac output by more than 70%; however, the degree of augmentation did not correlate with clinical benefit.

Data critically important

Kapur cited the clinical importance of these data given the emerging use of newer RV support technology. In addition, he noted that the early identification of RV failure and rapid deployment of mechanical support therapies may improve clinical outcomes in such patients.

“The ability for interventionalists to now support both the right and left ventricles using percutaneous technologies could greatly enhance our approaches to patients with coronary disease, cardiogenic shock, decompensated HF, valvular disease and pulmonary hypertension,” Kapur told TCT Daily. “The addition of RV support devices to the interventional HF armamentarium is critical as the role of the interventional cardiologist in managing patients with acute and chronic HF continues to grow.”

Kapur and colleagues are planning to expand their study to include more centers using percutaneous technologies such as the TandemHeart and Impella RP (Abiomed) systems for RV failure.

Study details

All patients presented with evidence of RV failure documented by echocardiography and invasive hemodynamic measurement. Patients in the registry had a wide variety of clinical presentations including chronic HF (7%), myocarditis (7%), post-valve surgery (32%), post-orthotopic heart transplant (11%), post-left ventricular assist device surgery (11%), post-CABG (7%) and acute MI (26%). Twenty-four percent of patients underwent concomitant placement of an LV assist device due to biventricular failure.