Daniel Kretzschmar1, Alexander Lauten2, Markus W Ferrari3. 1. Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University, Jena - Germany. 2. Department of Cardiology, Charité - University Medicine Berlin, Berlin - Germany. 3. HSK, Clinic of Internal Medicine I, Helios-Kliniken, Wiesbaden - Germany.
Abstract
PURPOSE: Acute right ventricular failure is a life-threatening condition with poor prognosis. It occurs as a result of right ventricular infarction, postcardiac transplantation, or postimplantation of a left ventricular assist device. Temporary mechanical right ventricular support could be a reasonable treatment option. Therefore, we developed a novel percutaneously implantable device. METHODS: The PERKAT device consists of a self-expandable chamber covered with multiple inflow valves carrying foils. A flexible outlet tube with a pigtail tip is attached to the distal end. PERKAT is designed for percutaneous implantation through the femoral vein (18 French sheath). The chamber is expanded in the inferior vena cava while the outlet tube bypasses the right heart and the pigtail tip is lying in the pulmonary trunk. An IABP balloon is inserted into the chamber and connected to an IABP console. Balloon deflation generates blood flow from the vena cava into the chamber through the foil valves. During inflation blood is pumped through the tube into the pulmonary arteries. RESULTS: In vitro experiments were performed using 30 mL and 40 mL IABP balloons. IABP inflation/deflation times were set to 80, 90, 100, and 110 per min with an afterload of 22 mmHg and 44 mmHg. PERKAT generated flow rates between 1.6 to 3.1 l/min, depending on balloon size, pump cycle, and afterload. CONCLUSIONS: The novel percutaneously implantable right ventricular assist device offers emergency support of up to 3 l/min. Based on the successful in vitro evaluation, we recommend the system as a promising approach for treatment of patients in need of RV support.
PURPOSE: Acute right ventricular failure is a life-threatening condition with poor prognosis. It occurs as a result of right ventricular infarction, postcardiac transplantation, or postimplantation of a left ventricular assist device. Temporary mechanical right ventricular support could be a reasonable treatment option. Therefore, we developed a novel percutaneously implantable device. METHODS: The PERKAT device consists of a self-expandable chamber covered with multiple inflow valves carrying foils. A flexible outlet tube with a pigtail tip is attached to the distal end. PERKAT is designed for percutaneous implantation through the femoral vein (18 French sheath). The chamber is expanded in the inferior vena cava while the outlet tube bypasses the right heart and the pigtail tip is lying in the pulmonary trunk. An IABP balloon is inserted into the chamber and connected to an IABP console. Balloon deflation generates blood flow from the vena cava into the chamber through the foil valves. During inflation blood is pumped through the tube into the pulmonary arteries. RESULTS: In vitro experiments were performed using 30 mL and 40 mL IABP balloons. IABP inflation/deflation times were set to 80, 90, 100, and 110 per min with an afterload of 22 mmHg and 44 mmHg. PERKAT generated flow rates between 1.6 to 3.1 l/min, depending on balloon size, pump cycle, and afterload. CONCLUSIONS: The novel percutaneously implantable right ventricular assist device offers emergency support of up to 3 l/min. Based on the successful in vitro evaluation, we recommend the system as a promising approach for treatment of patients in need of RV support.