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Pulmonary artery dissection in a patient with right-sided mechanical circulatory support and an LVAD

      The use of a left ventricular assist device (LVAD) is an essential treatment option for patients with advanced heart failure, as both a bridge to transplant and a destination therapy. It is important to consider the risks associated with an LVAD, however, as complications can present with a range of severity and chronicity. In the perioperative setting of LVAD implantation, right ventricular failure (RVF) can occur in an estimated 20% of patients.
      • Ravichandran AK
      • Baran DA
      • Stelling K
      • et al.
      Outcomes with the Tandem Protek Duo dual-lumen percutaneous right ventricular assist device.
      ,
      • Kirklin JK
      • Naftel DC
      • Pagani FD
      • et al.
      Seventh INTERMACS annual report: 15,000 patients and counting.
      RVF increases both morbidity and mortality, and it is reported that the 1-year survival rate is 60% in patients requiring biventricular support devices.
      • Ravichandran AK
      • Baran DA
      • Stelling K
      • et al.
      Outcomes with the Tandem Protek Duo dual-lumen percutaneous right ventricular assist device.
      ,
      • Kirklin JK
      • Naftel DC
      • Pagani FD
      • et al.
      Seventh INTERMACS annual report: 15,000 patients and counting.
      Temporary percutaneous right ventricular assist devices (RVAD) can be used until hemodynamic stability is achieved, or until the patient is bridged to a permanent RVAD or cardiac transplantation. In recent years, the TandemLife ProtekDuo (TandemLife, Pittsburg, PA) (TPD) or the CentriMag (Abbott, Chicago, IL) have been introduced as options for temporary right ventricular support. However, temporary RVADs also can cause a variety of complications, including, but not limited to, tricuspid regurgitation, hemolysis, cannula migration, or cerebrovascular insults.
      • Ravichandran AK
      • Baran DA
      • Stelling K
      • et al.
      Outcomes with the Tandem Protek Duo dual-lumen percutaneous right ventricular assist device.
      ,
      • Salna M
      • Garan AR
      • Kirtane AJ
      • et al.
      Novel percutaneous dual-lumen cannula-based right ventricular assist device provides effective support for refractory right ventricular failure after left ventricular assist device implantation.
      When indicated, patients who require biventricular devices are at much higher risk of complications and adverse events, as compared to those with an LVAD or RVAD alone. Despite the documented risk, temporary RVADs remain one of very few options to treat RVF perioperatively and must be considered.

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