Implantation of a Right Heart Assist Device without a Heart-Lung Machine in a Patient with an Acontractile Right Ventricle and HIT Type II

Introduction

Ventricular assist devices are increasingly used to support failing hearts until recovery of pump function or as a bridge to heart transplantation. Available systems include intracorporeal as well as paracorporeal pumps, and are driven electrically or pneumatically. In the majority of cases, only left heart support (LVAD) is provided. This is associated with a better outcome and fewer complications but carries the risk of right heart failure. This is highly lethal unless a right ventricular assist device (RVAD) is added [[1], [2]]. If right ventricular contractile function is virtually absent and the lung is perfused according to Fontan's principle, side-clamping of the main pulmonary artery may not be hemodynamically tolerated due to the afterload increase. Extracorporeal circulation is required to unload the right heart and to supply adequate aortic flow.

We present a technique for the insertion of an RVAD without the use of a heart-lung machine and without full anticoagulation.

References

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