Transseptal cannulation case of MoyoAssist by Guangdong Provincial People's Hospital

On August 8th, 2022, the team of Prof. Jinsong Huang, Prof. Min Wu, and Prof. Mingjie Mai from the Department of Cardiovascular Surgery of Guangdong Provincial People's Hospital, together with Prof. Junqing Yang from the Department of Cardiology and Prof. Jiexian Liang from the Department of Anesthesiology, successfully placed a 59-year-old male patient with MoyoAssist® Extra-VAD to provide stable circulatory support. The patient was diagnosed with dilated cardiomyopathy (DCM) and had acute heart failure. The patient was transferred to the ICU after the procedure. After his vital sign was stable, the heart transplant was completed.

Team of clinicians at Guangdong Provincial People's Hospital

Patient's preoperative demographic

The patient was a 59-year-old male who had recurrent chest tightness for around a year, and the situation had kept deteriorated. He was diagnosed with dilated cardiomyopathy, acute left heart failure, and acute respiratory failure. As the patient was severely-ill and had hemodynamic instability, he was transferred to the ICU.

Ultrasound before extracorporeal artificial heart placement

Based on the echocardiogram, the patient had an enlarged left ventricle. His left ventricular systolic function was significantly reduced, with EF 29%, having severe mitral regurgitation, mild pulmonary valve and tricuspid regurgitation, and severe pulmonary hypertension.

Surgical Strategy

In view of the patient's critical condition, the decision was made to place the MoyoAssist® Extra-VAD for circulatory support after family consent.A minimally invasive interventional approach was used to cannulate left atrium (via the right femoral vein), right axillary artery to establish left ventricular assist.

Intraoperative procedure

Via right femoral vein puncture, the 19F left atrial drainage cannula was delivered. The tube was fixed after the side drainage hole was completely entered into the left atrium. This transseptal cannulation was completed under Echo and X-ray guidance.

Transseptal Puncture

A drainage path was established through the femoral vein, to the left atrium via transseptal technic, the axillary artery was exposed, while placing an 18Fr arterial cannula before innominate artery opening. This established a left atrial-axillary artery circulatory support.

TEE observation had shown decreased pulmonary artery pressure, improved mitral-tricuspid regurgitation, reduced left ventricular end-diastolic volume, and improved contractility; the extra-VAD operated with an immediate intraoperative urine volume of 500 ml, followed by successful completion of the procedure and transfer to the ICU.

Postoperative condition

Postoperatively, the patient's condition was stable in ICU, he left atrial cannula was in place, without any dislodgement. The extra-VAD was performing well.

After a week of extra-VAD support, the patient received his donor heart on the 8th postoperative day. The heart transplant was completed and the extra-VAD was removed. The patient has recovered well by then.