Percutaneous Biventricular Mechanical Circulatory Support With Impella CP and Protek Duo Plus TandemHeart

J INVASIVE CARDIOL 2019;31(2):E46.

Key words: cardiac imaging, mechanical circulatory support

A 58-year-old female with no prior medical history presented with cardiogenic shock due to viral myocarditis. She had angiographically normal coronary arteries. Bedside echocardiogram showed global hypokinesis of the left ventricle (LV) with left ventricular ejection fraction (LVEF) of 10%. Right ventricular (RV) function was severely impaired. That patient needed biventricular mechanical circulatory support (MCS). Using moderate sedation, an Impella CP (Abiomed) was placed percutaneously through the left axillary artery. Subsequently, a Protek Duo device (LivaNova) was inserted into the right internal jugular (IJ) vein, positioned distally into the main pulmonary artery (PA), and connected to a TandemHeart pump (LivaNova) (Figure 1). The patient was able to ambulate with careful supervision. Biventricular support resulted in stable hemodynamics. The biventricular support devices were weaned and removed on hospital day 6. LVEF on discharge was 50%.   To our knowledge, this is the first reported case of full biventricular MCS with the combination of Impella and Protek Duo. The Protek Duo is a dual-lumen cannula inserted via the right IJ vein, with its proximal inflow lumen positioned in the right atrium and distal lumen positioned in the main PA. These lumens are connected with the paracorporeal TandemHeart pump, which allows flow of up to 5 L/min. The alternative percutaneous option for RV support is the Impella RP (Abiomed), which must be placed in the femoral vein, preventing ambulation. The axillary and IJ vein positions for devices are probably less prone to infection compared with the femoral area. The combination of an Impella inserted via the axillary artery with the Protek Duo is a viable option, allowing ambulation while providing biventricular support.

From the University of Arizona College of Medicine, Phoenix, Arizona.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted September 17, 2018.

Address for correspondence: Nachiket Patel, MD, Banner University Medical Center, 1111 East McDowell Rd, Phoenix, AZ 85006. Email: nachiketjpatel@gmail.com