The Role of TandemHeart ^TM combined with ProtekDuo ^TM as Right Ventricular Support Device: A Simulation Approach

Right ventricular failure increases short-term mortality in the setting of acute myocardial infarction, cardiogenic shock, advanced left-sided heart failure and pulmonary hypertension. Right ventricular failure remains quite a challenging condition to manage in view of its complex background and still incomplete understanding of its pathophysiology. Percutaneous and surgically implanted right ventricular assist devices (RVADs) have been investigated in different clinical settings. The use of the ProtekDuo ^TM (LivaNova, London, UK) is currently a promising approach due to its features such as groin-free approach leading to early mobilisation, easy percutaneous deployment, compatibility with different pumps and oxygenators, and adaptability to different configurations. The aim of this work was to simulate the behaviour of the TandemHeart ^TM pump applied “ in series ” and “ in parallel “ mode and the combination of TandemHeart ^TM and ProtekDuo ^TM cannula as right ventricular assist device using CARDIOSIM ^© software simulator platform. The effects induced on the main hemodynamic and energetic variables were analysed for both the right atrial-pulmonary arterial and right ventricular-pulmonary arterial configuration with different pump rotational speed and following of Milrinone administration. The TandemHeart ^TM increased right ventricular end systolic volume by 10%, larger increases were evident for higher speeds (6000 and 7500 rpm) and connections with 21 Fr inflow and 17 Fr outflow cannula, respectively. Both TandemHeart ^TM and ProtekDuo ^TM support increased left ventricular preload. When different RVAD settings were used, Milrinone therapy increased the left ventricular pressure-volume area and decreased the right pressure-volume area slightly. A reduction in oxygen consumption (demand) was observed with reduced right stroke work and pressure volume area and increased oxygen supply (coronary blood flow).