JTCVS Techniques | 2021
Commentary: Superior vena cava syndrome should not hinder use of a percutaneous right ventricular assist device
Abstract
Long-term implantable ventricular assist devices are being increasingly accepted as a surgical modality in patients with left ventricular failure from a variety of etiologies. The right side of the heart has no such durable, implantable option. Right-sided heart failure can occur after myocardial infarction, pulmonary embolism, cardiac surgery, and left ventricular assist device implantation. Despite these severe insults, the right ventricle has been shown to be more resilient, owing to reduced oxygen demand, a dual coronary blood supply, and more consistent transmural perfusion across the ventricular wall. As such, enthusiasm exists for the use of a temporary right ventricular assist device (RVAD) as a bridge to recovery. With increased experience, temporary percutaneous RVAD use in severe RV failure is rising. The two most common devices are the Impella R, introduced via the femoral vein and the Protek Duo, a dual-lumen cannula (DLC) introduced by way of the right internal jugular (RIJ) vein. For many, the use of a DLC via the RIJ is the best method, given the better ability to ambulate while awaiting RV recovery. There remain no articles describing the rare but dreaded complication of superior vena cava (SVC) syndrome.