Percutaneous right ventricular assist apparatus and method

Abstract

A system for assisting the right heart of a patient includes a PA cannula adapted for insertion into a PA of a patient through the right internal jugular vein of the patient. The system includes a percutaneous RA cannula adapted for insertion into an RA of the patient. The system includes a blood pump disposed outside of the patient to which the RA cannula and the PA cannula are connected to provide right ventricular circulatory support to the patient without any left ventricular assist. A method for assisting the right heart of a patient includes the steps of inserting a PA cannula into a PA of a patient. There is the step of inserting an RA cannula into an RA of the patient. There is the step of connecting the RA cannula and the PA cannula to a blood pump disposed outside of the patient. There is the step of activating the blood pump to provide right ventricular circulatory support to assist the heart of the patient.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

In the accompanying drawings, the preferred embodiment of the invention and preferred methods of practicing the invention are illustrated in which:

FIG. 1 is a schematic representation of a right internal jugular vein punctured with a needle. The wire is then advanced into the right atrium.

FIG. 2 is a schematic representation of a 17Fr wire-reinforced cannula and introducer advanced into the right atrium after dilating the skin site and the vein.

FIG. 3 is a schematic representation of the 17Fr cannula in the right atrium.

FIG. 4 is a schematic representation of a 7Fr Swan-Ganz catheter that has passed through the cannula and floated into the right pulmonary artery.

FIG. 5 is a schematic representation of a super-stiff wire passed through the Swan-Ganz catheter to stiffen it.

FIG. 6 is a schematic representation of the 17Fr cannula advanced over the Swan-Ganz catheter until it sits in the distal main pulmonary artery. The Swan-Ganz catheter and the wire are removed, leaving the cannula in position.

FIG. 7 is a schematic representation of the 21Fr venous drainage cannula advanced from the femoral vein over a wire, using the Seldinger technique.

FIG. 8 is a schematic representation of the 21Fr venous drainage cannula positioned in the right atrium and the 17 Fr return cannula in the main pulmonary artery.

FIG. 9 is a schematic representation of the system of the present invention.

Claims

1. A method for assisting the heart of a patient comprising the steps of: inserting a PA cannula into a PA of a patient;inserting an RA cannula into an RA of the patient;connecting the RA cannula and the PA cannula to a blood pump disposed outside of the patient; andactivating the blood pump to provide right ventricular assist to the heart of the patient.

2. A method as described in claim 1 wherein the activating step includes the step of providing flow from the blood pump for right ventricular assist of the patient at a level which is ½ to ⅔ of normal cardiac flow of the patient.

3. A method as described in claim 2 wherein the activating step includes the step of providing only right ventricular assist with the blood pump to the patient without any left ventricular assist.

4. A method as described in claim 3 wherein the inserting the PA cannula step includes the step of passing a pulmonary wedge pressure catheter through the cannula, floating the catheter into the pulmonary artery, and advancing a super stiff wire through a pulmonary artery port of the Swan-Ganz catheter.

5. A method as described in claim 4 wherein the PA cannula has an end hole and at least two side holes which allow blood flow to the left and right lungs of the patient, without allowing backflow into the right ventricle of the patient.

6. A method as described in claim 5 wherein no open chest surgery occurs.

7. A method as described in claim 6 wherein the inserting the RA cannula step includes the step of inserting the RA cannula percutaneously into the RA of the patient.

8. A method as described in claim 7 wherein the right ventricle of the patient is totally bypassed.

9. A method as described in claim 8 wherein the activating step includes the step of pumping unoxygenated blood from the right atrium with the blood pump through the percutaneous RA cannula and returning the blood to the pulmonary artery through the PA cannula.

10. A method as described in claim 9 wherein the pumping step includes the step of controlling the pump with a controller in communication with the pump which detects and manages faults and produces an alert signal in response to a detected fault.

11. A method as described in claim 10 including the step of placing the pump in a holder that attaches to the lower body of the patient.

12. A method as described in claim 11 including the step of sewing the PA cannula and the RA cannula to the patient.

13. A method as described in claim 12 wherein the inserting the PA cannula step includes the step of inserting the PA cannula through the right internal jugular vein of the patient.

14. A method as described in claim 13 wherein the inserting the PA cannula step includes the step of removing the pulmonary wedge pressure catheter and the wire from the patient once the PA cannula is in the patient.

15. A method as described in claim 14 wherein the inserting the RA cannula step includes the step of inserting the RA cannula into a peripheral vein of the patient over a wire.

16. A method as described in claim 15 wherein the inserting the RA cannula step includes the step of advancing the RA cannula along the long wire into the RA and removing the long wire.

17. A method as described in claim 16 wherein the activating step includes the step of starting 2 L/min flow for at least two minutes and then adjusting the flow based on the patient's requirements.

18. A method as described in claim 17 including the step of using imaging guidance when the RA cannula and the PA cannula are placed in the RA and PA, respectively.

19. A system for assisting the right heart of a patient comprising: a PA cannula adapted for insertion into a PA of a patient through the right internal jugular vein of the patient;a percutaneous RA cannula adapted for insertion into an RA of the patient; anda blood pump disposed outside of the patient to which the RA cannula and the PA cannula are connected to provide right ventricular circulatory support to the patient without any left ventricular assist.

20. A system as described in claim 19 wherein the pump is a ventricular assist pump.