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Schweiger M, Hussein H, de By TMMH, Zimpfer D, Sliwka J, Davies B, Miera O, Meyns B. Use of Intracorporeal Durable LVAD Support in Children Using HVAD or HeartMate 3-A EUROMACS Analysis. J Cardiovasc Dev Dis 2023; 10:351. [PMID: 37623364 PMCID: PMC10455245 DOI: 10.3390/jcdd10080351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Purpose: The withdrawal of HVAD in 2021 created a concern for the pediatric population. The alternative implantable centrifugal blood pump HeartMate 3 has since been used more frequently in children. This paper analyses the outcome of children on LVAD support provided with an HVAD or HM3. Methods: A retrospective analysis of the EUROMACS database on children supported with VAD < 19 years of age from 1 January 2009 to 1 December 2021 was conducted. All patients with an LVAD and either an HVAD or HM3 were included. Patients with missing data on VAD status and/or missing baseline and/or follow up information were excluded. Kaplan-Meier survival analysis was performed to evaluate survival differences. Analyses were performed using Fisher's exact test. Results: The study included 150 implantations in 142 patients with 128 implants using an HVAD compared to 28 implants using an HM3. Nine patients (6%) needed temporary right ventricular mechanical support, which was significantly higher in the HM3 group, with 25% (p: 0.01). Patients in the HVAD group were significantly younger (12.7 vs. 14.5 years, p: 0.01), weighed less (45.7 vs. 60 kg, p: <0.000) and had lower BSA values (1.3 vs. 1.6 m2, p: <0.000). Median support time was 204 days. Overall, 98 patients (69%) were discharged and sent home, while 87% were discharged in group HM3 (p: ns). A total of 123 children (86%) survived to transplantation, recovery or are ongoing, without differences between groups. In the HVAD group, 10 patients (8%) died while on support, whereas in 12% of HM3 patients died (p: 0.7). Conclusions: Survival in children implanted with an HM3 was excellent. Almost 90% were discharged and sent home on the device.
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Affiliation(s)
- Martin Schweiger
- Department of Congenital Cardiovascular Surgery, Pediatric Heart Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Hina Hussein
- Quality and Outcomes Research Unit, University Hospital Birmingham, Birmingham B15 2TH, UK;
| | | | - Daniel Zimpfer
- Department for Heart Surgery, Medical University Graz, Graz A-8010, Austria
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland
| | - Ben Davies
- Royal Children’s Hospital, Melbourne 3052, Australia;
| | - Oliver Miera
- Department of Congenital Heart Diseases—Pediatric Cardiology, Deutsches Herzzentrum der Charité, 13353 Berlin, Germany;
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium;
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2
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Yang W, Conover TA, Figliola RS, Giridharan GA, Marsden AL, Rodefeld MD. Passive performance evaluation and validation of a viscous impeller pump for subpulmonary fontan circulatory support. Sci Rep 2023; 13:12668. [PMID: 37542111 PMCID: PMC10403595 DOI: 10.1038/s41598-023-38559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/11/2023] [Indexed: 08/06/2023] Open
Abstract
Patients with single ventricle defects undergoing the Fontan procedure eventually face Fontan failure. Long-term cavopulmonary assist devices using rotary pump technologies are currently being developed as a subpulmonary power source to prevent and treat Fontan failure. Low hydraulic resistance is a critical safety requirement in the event of pump failure (0 RPM) as a modest 2 mmHg cavopulmonary pressure drop can compromise patient hemodynamics. The goal of this study is therefore to assess the passive performance of a viscous impeller pump (VIP) we are developing for Fontan patients, and validate flow simulations against in-vitro data. Two different blade heights (1.09 mm vs 1.62 mm) and a blank housing model were tested using a mock circulatory loop (MCL) with cardiac output ranging from 3 to 11 L/min. Three-dimensional flow simulations were performed and compared against MCL data. In-silico and MCL results demonstrated a pressure drop of < 2 mmHg at a cardiac output of 7 L/min for both blade heights. There was good agreement between simulation and MCL results for pressure loss (mean difference - 0.23 mmHg 95% CI [0.24-0.71]). Compared to the blank housing model, low wall shear stress area and oscillatory shear index on the pump surface were low, and mean washout times were within 2 s. This study demonstrated the low resistance characteristic of current VIP designs in the failed condition that results in clinically acceptable minimal pressure loss without increased washout time as compared to a blank housing model under normal cardiac output in Fontan patients.
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Affiliation(s)
- Weiguang Yang
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, USA.
| | - Timothy A Conover
- Departments of Mechanical Engineering, Clemson University, Clemson, SC, USA
| | - Richard S Figliola
- Departments of Mechanical Engineering, Clemson University, Clemson, SC, USA
| | | | - Alison L Marsden
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Mark D Rodefeld
- Section of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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3
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Kozik D, Alsoufi B. Pediatric mechanical circulatory support - a review. Indian J Thorac Cardiovasc Surg 2023; 39:80-90. [PMID: 37525715 PMCID: PMC10386992 DOI: 10.1007/s12055-023-01499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/29/2023] Open
Abstract
The history of mechanical circulatory support began in 1953, as the first heart-lung machine enabled surgeons to perform complex open heart surgery. Heart failure is more prevalent in adults than pediatric patients which has led to the development of devices for adults with end-stage heart failure at a faster pace. Pediatric mechanical circulatory support has been derived from adult durable devices and subsequently applied in the adolescent population. The application of adult devices in children is inherently problematic due to size mismatch, especially in smaller patients. There has been an increasing interest in developing durable pumps that are appropriate for children for several reasons, with the primary factor being the number of children with end-stage heart failure far exceeding the number of potential donors. Mechanical circulatory support (MCS) for children can be divided into short-term temporary support and long-term durable support. The goal of this review is to discuss the devices available for the pediatric population and review the options for support in complex patients including single-ventricle anatomy, biventricular support, and total artificial heart options. We will also briefly discuss the Pumps for Kids, Infants, and Neonates (PumpKIN) Trial and MCS registries, including the Advanced Cardiac Therapies Improving Outcomes Network (ACTION).
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Affiliation(s)
- Deborah Kozik
- Department of Cardiovascular and Thoracic Surgery, Norton Children’s Hospital, University of Louisville School of Medicine, Louisville, KY USA
| | - Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, Norton Children’s Hospital, University of Louisville School of Medicine, Louisville, KY USA
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4
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Shinkawa T, Ichihara Y, Saito S, Ishido M, Inai K, Niinami H. Ventricular assist device for end-stage adult congenital heart disease patients: Current status. J Cardiol 2023; 81:378-384. [PMID: 36152979 DOI: 10.1016/j.jjcc.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022]
Abstract
As long-term surgical outcome of congenital heart disease has continued to improve, most pediatric patients with congenital heart disease are able to reach adulthood. However, adult congenital heart disease (ACHD) patients have increased risk of arrhythmia, valvular diseases, infectious endocarditis, and heart failure. The end-stage ACHD patients with advanced heart failure may require mechanical circulatory support to improve the heart failure symptoms or to recover from circulatory collapse, and may eventually aim to heart transplant or destination therapy. In general, long-term mechanical support for dilated cardiomyopathy or ischemic cardiomyopathy has been achieved with left ventricular assist device with excellent survival outcomes and improved quality of life. However, the ventricular assist device for end-stage ACHD patients can be challenging due to patient-specific anatomical feature, multiple histories of surgical and catheter-based interventions and possible multiple end-organ dysfunctions, and offered less frequently compared to non-ACHD patients. The Interagency Registry for Mechanically Assisted Circulatory Support data published recently showed that ACHD patients receiving long-term mechanical circulatory support consisted <1 % of all registrants and had higher mortality after mechanical support than non-ACHD patients. However, the ACHD patients supported with left ventricular assist device had similar survival with non-ACHD patients and a large proportion of the mortality difference between ACHD and non-ACHD patients seemed to result from operative and perioperative factors. Therefore, the ventricular assist device therapy can be an excellent treatment for selected ACHD patients. In this paper, we describe the current status of ventricular assist device support for end-stage ACHD patients and consideration to the future.
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Affiliation(s)
- Takeshi Shinkawa
- Tokyo Women's Medical University, Department of Cardiovascular Surgery, Tokyo, Japan.
| | - Yuki Ichihara
- Tokyo Women's Medical University, Department of Cardiovascular Surgery, Tokyo, Japan
| | - Satoshi Saito
- Tokyo Women's Medical University, Department of Cardiovascular Surgery, Tokyo, Japan
| | - Mikiko Ishido
- Tokyo Women's Medical University, Department of Pediatric and Adult Congenital Cardiology, Tokyo, Japan
| | - Kei Inai
- Tokyo Women's Medical University, Department of Pediatric and Adult Congenital Cardiology, Tokyo, Japan
| | - Hiroshi Niinami
- Tokyo Women's Medical University, Department of Cardiovascular Surgery, Tokyo, Japan
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5
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Hanuna M, Pabst von Ohain J, Haas N, Mueller CS, Dalla-Pozza R, Fischer M, Born F, Kamla C, Jakob A, Hagl C, Hörer J, Michel SG. Case report: Heart Mate III for systemic right ventricular support in a patient with hypoplastic left heart syndrome. Front Cardiovasc Med 2023; 9:1070314. [PMID: 36741835 PMCID: PMC9892053 DOI: 10.3389/fcvm.2022.1070314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023] Open
Abstract
Ventricular assist device implantation presents a possible bridge to heart transplantation for patients with failing Fontan physiology. However, evidence regarding outcome and possible pitfalls associated with the Fontan circulation is still insufficient. We describe the course of a 13-year-old male, who was born with hypoplastic left heart syndrome and underwent HeartMate III implantation due to refractory failure of the systemic right ventricle.
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Affiliation(s)
- Maja Hanuna
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jelena Pabst von Ohain
- Division of Congenital and Pediatric Heart Surgery, Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany,Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nikolaus Haas
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christoph S. Mueller
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Robert Dalla-Pozza
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilian University of Munich, Munich, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilian University of Munich, Munich, Germany
| | - Frank Born
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christine Kamla
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Andre Jakob
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany,Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany
| | - Jürgen Hörer
- Division of Congenital and Pediatric Heart Surgery, Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany,Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Sebastian G. Michel
- Division of Congenital and Pediatric Heart Surgery, Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany,Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany,*Correspondence: Sebastian G. Michel,
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6
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Abstract
To address the increasing number of failing Fontan patients, Penn State University and the Penn State Hershey Medical Center are developing a centrifugal blood pump for long-term mechanical support. Computational fluid dynamics (CFD) modeling of the Penn State Fontan Circulatory Assist Device (FCAD) was performed to understand hemodynamics within the pump and its potential for hemolysis and thrombosis. CFD velocity and pressure results were first validated against experimental data and found to be within the standard deviations of the velocities and within 5% of the pressures. Further simulations performed with a human blood model found that most of the fluid domain was subjected to low shear stress (<50 Pa), with areas of highest stress around the rotor blade tips that increased with pump flow rate and rotor speed (138-178 Pa). However, the stresses compared well to previous CFD studies of commercial blood pumps and remained mostly below common thresholds of hemolysis and platelet activation. Additionally, few regions of low shear rate were observed within the FCAD, signifying minimal potential for platelet adhesion. These results further emphasize the FCAD's potential that has been observed previously in experimental and animal studies.
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7
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Neethling E, Heggie JE. Considerations in Critical Care and Anesthetic Management of Adult Patients Living with Fontan Circulation. Can J Cardiol 2022; 38:1100-1110. [PMID: 35490923 DOI: 10.1016/j.cjca.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/02/2022] Open
Abstract
The Fontan procedure is a staged palliation for various complex congenital cardiac lesions, including tricuspid atresia (TA), pulmonary atresia (PA), hypoplastic left heart syndrome (HLHS), and double inlet left ventricle (DILV), all of which involve a functional single-ventricle physiology. The complexity of the patients' original anatomy combined with the anatomical and physiological consequences of the Fontan circulation creates challenges. Teens and adults living with Fontan palliation will need perioperative support for non-cardiac surgery, peripartum management for labor and delivery, interventions related to their structural heart disease, electrophysiology procedures, pacemakers, cardioversions, cardiac surgery, transplant, and advanced mechanical support. This review focuses on the anesthetic and ICU management of these patients during their perioperative journey, with an emphasis on the continuity of pre-intervention planning, referral pathways, and post-intervention intensive care unit (ICU) management. Requests for recipes and doses of medications are frequent; however, as in normal anesthesia and ICU practice, the method of anesthesia and dosing are dependent on the presenting medical/surgical conditions and the underlying anatomy and physiological reserve. A patient with Fontan palliation in their early 20s attending school full-time with a cavopulmonary connection is likely to have more reserve than a patient in their late 40s with an atrio- pulmonary (AP) Fontan at home waiting for a heart transplant. Each case will require an anesthetic and critical care plan tailored to their situation. The critical care environment is a natural extension of the anesthetic management of a patient, with complex considerations for a patient with Fontan palliation.
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Affiliation(s)
| | - Jane E Heggie
- Toronto General Hospital, University Health Network, Toronto.
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8
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Tobin N, Good BC, Plasencia JD, Fogel MA, Weiss WJ, Manning KB. Computational Investigation of Anastomosis Options of a Right-Heart Pump to Patient Specific Pulmonary Arteries. Ann Biomed Eng 2022; 50:929-940. [PMID: 35451680 DOI: 10.1007/s10439-022-02969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
Patients with Fontan circulation have increased risk of heart failure, but are not always candidates for heart transplant, leading to the development of the subpulmonic Penn State Fontan Circulation Assist Device. The aim of this study was to use patient-specific computational fluid dynamics simulations to evaluate anastomosis options for implanting this device. Simulations were performed of the pre-surgical anatomy as well as four surgical options: a T-junction and three Y-grafts. Cases were evaluated based on several fluid-dynamic quantities. The impact of imbalanced left-right pulmonary flow distribution was also investigated. Results showed that a 12-mm Y-graft was the most energy efficient. However, an 8-mm graft showed more favorable wall shear stress distribution, indicating lower risk of thrombosis and endothelial damage. The 8-mm Y-grafts also showed a more balanced pulmonary flow split, and lower residence time, also indicating lower thrombosis risk. The relative performance of the surgical options was largely unchanged whether or not the pulmonary vascular resistance remained imbalanced post-implantation.
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Affiliation(s)
- Nicolas Tobin
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Bryan C Good
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | | | - Mark A Fogel
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - William J Weiss
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, 17033, USA
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA. .,Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, 17033, USA.
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9
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Ono M, Yamaguchi O, Ohtani T, Kinugawa K, Saiki Y, Sawa Y, Shiose A, Tsutsui H, Fukushima N, Matsumiya G, Yanase M, Yamazaki K, Yamamoto K, Akiyama M, Imamura T, Iwasaki K, Endo M, Ohnishi Y, Okumura T, Kashiwa K, Kinoshita O, Kubota K, Seguchi O, Toda K, Nishioka H, Nishinaka T, Nishimura T, Hashimoto T, Hatano M, Higashi H, Higo T, Fujino T, Hori Y, Miyoshi T, Yamanaka M, Ohno T, Kimura T, Kyo S, Sakata Y, Nakatani T. JCS/JSCVS/JATS/JSVS 2021 Guideline on Implantable Left Ventricular Assist Device for Patients With Advanced Heart Failure. Circ J 2022; 86:1024-1058. [PMID: 35387921 DOI: 10.1253/circj.cj-21-0880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Kenji Yamazaki
- Advanced Medical Research Institute, Hokkaido Cardiovascular Hospital
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Teruhiko Imamura
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Graduate School of Advanced Science and Engineering, Waseda University
| | - Miyoko Endo
- Department of Nursing, The University of Tokyo Hospital
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Koichi Kashiwa
- Department of Medical Engineering, The University of Tokyo Hospital
| | - Osamu Kinoshita
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | - Kaori Kubota
- Department of Transplantation Medicine, Osaka University Graduate School of Medicine
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroshi Nishioka
- Department of Clinical Engineering, National Cerebral and Cardiovascular Center
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center
| | - Takashi Nishimura
- Department of Cardiovascular and Thoracic Surgery, Ehime University Hospital
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Masaru Hatano
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Yumiko Hori
- Department of Nursing and Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Toru Miyoshi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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10
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Townsend M, Jeewa A, Adachi I, Al Aklabi M, Honjo O, Armstrong K, Buchholz H, Conway J. Ventricular Assist Device Use in Single Ventricle Circulation. Can J Cardiol 2022; 38:1086-1099. [DOI: 10.1016/j.cjca.2022.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 01/09/2023] Open
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11
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Ponnaluri S, Christensen E, Good B, Kubicki C, Deutsch S, Cysyk J, Weiss WJ, Manning KB. Experimental Hemodynamics within the Penn State Fontan Circulatory Assist Device. J Biomech Eng 2021; 144:1129243. [PMID: 34897373 DOI: 10.1115/1.4053210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Indexed: 11/08/2022]
Abstract
For children born with a single functional ventricle, the Fontan operation bypasses the right ventricle by forming a four-way total cavopulmonary connection adapting the existing ventricle for the systemic circulation. However, upon adulthood, many Fontan patients exhibit low cardiac output and elevated venous pressure, eventually requiring a heart transplantation. Despite efforts to develop a Fontan pump or use an existing ventricular assist device for failing Fontan support, there is still no device designed or tested for subpulmonary support. Penn State University is developing a hydrodynamically levitated Fontan circulatory assist device (FCAD) for bridge-to-transplant or destination therapy. The FCAD hemodynamics, at both steady and pulsatile conditions for three pump operating conditions, were quantified using particle image velocimetry to determine the velocity magnitudes and Reynolds normal and shear stresses. Data were acquired at three planes (0 mm and ±25% of the radius) for the inferior and superior vena cavae inlets and the pulmonary artery outlet. The inlets had a blunt velocity profile that became skewed towards the collecting volute as fluid approached the rotor. At the outlet, regardless of the flow condition, a high-velocity jet exited the volute and moved downstream in a helical pattern. Turbulent stresses observed at the volute exit were influenced by the rotor's rotation. Regardless of inlet conditions, the pump demonstrated advantageous behavior for clinical use with a predictable flow field and a low risk of platelet adhesion and hemolysis based on calculated wall shear rates and turbulent stresses, respectively.
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Affiliation(s)
- Sailahari Ponnaluri
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Emma Christensen
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Bryan Good
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Cody Kubicki
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Steven Deutsch
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Joshua Cysyk
- Department of Surgery, Penn State Hershey Medical Center, PA; H151 Surgery Hershey PA 17033, The Milton S. Hershey Medical Center
| | - William J Weiss
- Department of Surgery, Penn State Hershey Medical Center, PA; H151 Surgery Hershey PA 17033, The Milton S. Hershey Medical Center
| | - Keefe B Manning
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, Department of Surgery, Penn State Hershey Medical Center, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
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12
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Perry T, Lorts A, Morales DLS, Fields K, Fahnhorst SE, Brandewie K, Lubert A, Villa CR. Chronic Ventricular Assist Device Support in Adult Congenital Heart Disease Patients: A Children's Hospital Perspective. ASAIO J 2021; 67:e216-e220. [PMID: 34711747 DOI: 10.1097/mat.0000000000001595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With improvement in early surgical outcomes in patients with complex congenital heart disease, most patients are now expected to survive to adulthood. As adult congenital heart disease (ACHD) patients age, they are at risk of heart failure, which has become the leading cause of mortality in ACHD. Some who develop advanced heart failure may not be candidates for transplant, and chronic ventricular assist device (VAD) therapy may be the only means of survival. There is limited experience with chronic VAD therapy in ACHD patients, and the outcomes are not well delineated. We describe our center's experience with chronic VAD therapy in ACHD patients receiving care exclusively within our children's hospital.
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Affiliation(s)
- Tanya Perry
- From the Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
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13
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Szugye NA, Zafar F, Villa C, Lorts A, Morales DLS, Moore RA. 3D Holographic Virtual Surgical Planning for a Single Right Ventricle Fontan Patient Needing Heartmate III Placement. ASAIO J 2021; 67:e211-e215. [PMID: 34261876 DOI: 10.1097/mat.0000000000001487] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 15 year old female with hypoplastic left heart syndrome status post Norwood with Sano modification, bidirectional Glenn and extracardiac conduit Fontan developed severe right ventricular (RV) systolic dysfunction. Due to symptomatic heart failure, she underwent assessment for ventricular assist device (VAD) placement as a bridge-to-cardiac transplantation strategy. To evaluate her atypical anatomy, a chest computed tomography (CT) was uploaded into an EchoPixel True3D (Santa Clara, CA) view portal along with an accurately scaled 3D surface model of the HeartMate III (HM3) device. The surgeon then manipulated the position of the HM3 to evaluate multiple potential device positions in relation to anatomic features such as the intraventricular septum, tricuspid valve annulus, and RV muscle bundles. The patient was taken to the operating room and the HM3 device was placed just anterior to the RV apex as virtually planned. She had an uneventful postoperative course, underwent cardiac transplantation on postoperative day (POD) 63 and is doing well now 19 months post-transplantation.
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Affiliation(s)
- Nicholas A Szugye
- From the The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Farhan Zafar
- From the The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Chet Villa
- From the The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Angela Lorts
- From the The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David L S Morales
- From the The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ryan A Moore
- From the The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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14
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Systemic ventricular assist device support of the Fontan circulation yields promising outcomes: An analysis of The Society of Thoracic Surgeons Pedimacs and Intermacs Databases. J Thorac Cardiovasc Surg 2021; 164:353-364. [PMID: 35016782 DOI: 10.1016/j.jtcvs.2021.11.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/15/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Outcomes of ventricular assist device (VAD) support in patients with Fontan circulatory failure (or failing Fontan physiology) are largely unknown. METHODS We conducted a retrospective analysis of patients with a Fontan circulation who underwent VAD implant in the Society of Thoracic Surgeons Pedimacs and Intermacs Databases from September 19, 2012, to December 31, 2019. RESULTS We identified 55 Fontan patients who had undergone VAD implant with a median age at implantation of 10.2 years (interquartile range, 6.4-16.9 years) and weight, 26.8 kg (interquartile range, 17.7-53.8 years). More VADs were implanted in 2018-2019 than in 2012-2017 (28 vs 27; P = .01). The later era had higher pre-VAD glomerular filtration rate (101.1 ± 48.5 vs 71.2 ± 34.9; P = .02); there was no difference in Interagency Registry for Mechanically Assisted Circulatory Support profile (P = .69). Kaplan-Meier survival on device was 76% at 6 months with no difference by era. Competing outcomes demonstrated a positive outcome of 81% (alive on VAD, transplanted, or recovered) at 6 months, with 58% of mortality occurring during month 1. Median length of support was 3.8 months (interquartile range, 0.6-6.9 months). Five patients were supported for >1 year with no added mortality; the longest support time was 4 years, 7 months. Adverse event rates included pump thrombosis incidence of 4% (3.3 out of 100 patient-months), stroke 5.5% (1.4 out of 100 patient-months), gastrointestinal bleeding of 7% (2.6 out of 100 patient-months), and nongastrointestinal bleeding of 9% (2.3 out of 100 patient-months). CONCLUSIONS This is the largest reported analysis of systemic VAD support of Fontan patients. VAD support of the Fontan circulation is becoming more frequent. This analysis demonstrates that VAD use in this growing population can yield promising outcomes.
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15
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Wells DA, Coghill M, Szugye N, Moore R, Lorts A, Tweddell JS, Morales DLS. Transplantation and Arch Repair in Fontan 3 Years after HeartMate 3: Technical Considerations. Ann Thorac Surg 2021; 114:e5-e7. [PMID: 34742734 DOI: 10.1016/j.athoracsur.2021.09.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 11/28/2022]
Abstract
We previously reported the first successful implantation of the Heartmate 3TM in a Fontan patient. We now report his successful transplantation after 1,104 days of support, the longest reported bridge to transplantation of a Fontan patient. We describe our operative technique complicated by not only the Fontan anatomy and ventricular assist device (VAD) explanation but also a >10cm ascending and aortic arch aneurysm. Additionally, the post-transplant hemodynamics of this patient appear to demonstrate that effective VAD support may induce reversal of chronic effects of the failing Fontan circulation, which in this case was the elimination of his aorto-pulmonary collateral burden.
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Affiliation(s)
- Dennis A Wells
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Matthew Coghill
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Nicholas Szugye
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Ryan Moore
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Angela Lorts
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - James S Tweddell
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229.
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16
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Villa CR, Lorts A, Morales DLS. Ventricular Assist Device Therapy in the Fontan Circulation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2021; 24:19-25. [PMID: 34116777 DOI: 10.1053/j.pcsu.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/04/2021] [Accepted: 01/14/2021] [Indexed: 12/25/2022]
Abstract
The number of Fontan patients with circulatory failure and systolic dysfunction is growing rapidly. The last decade has demonstrated that ventricular assist device (VAD) is an effective therapy in properly selected patients. Herein, we discuss the current approach to patient selection, implantation, and patient management.
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Affiliation(s)
- Chet R Villa
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Angela Lorts
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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17
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Lorts A, Conway J, Schweiger M, Adachi I, Amdani S, Auerbach SR, Barr C, Bleiweis MS, Blume ED, Burstein DS, Cedars A, Chen S, Cousino-Hood MK, Daly KP, Danziger-Isakov LA, Dubyk N, Eastaugh L, Friedland-Little J, Gajarski R, Hasan A, Hawkins B, Jeewa A, Kindel SJ, Kogaki S, Lantz J, Law SP, Maeda K, Mathew J, May LJ, Miera O, Murray J, Niebler RA, O'Connor MJ, Özbaran M, Peng DM, Philip J, Reardon LC, Rosenthal DN, Rossano J, Salazar L, Schumacher KR, Simpson KE, Stiller B, Sutcliffe DL, Tunuguntla H, VanderPluym C, Villa C, Wearden PD, Zafar F, Zimpfer D, Zinn MD, Morales IRD, Cowger J, Buchholz H, Amodeo A. ISHLT consensus statement for the selection and management of pediatric and congenital heart disease patients on ventricular assist devices Endorsed by the American Heart Association. J Heart Lung Transplant 2021; 40:709-732. [PMID: 34193359 DOI: 10.1016/j.healun.2021.04.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 01/17/2023] Open
Affiliation(s)
- Angela Lorts
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
| | | | - Martin Schweiger
- Universitäts-Kinderspitals Zürich - Herzchirurgie, Zurich, Switzerland
| | - Iki Adachi
- Texas Children's Hospital, Houston, Texas
| | | | - Scott R Auerbach
- Anschutz Medical Campus, Children's Hospital of Colorado, University of Colorado Denver, Aurora, Colorado
| | - Charlotte Barr
- The Royal Children's Hospital, Victoria Melbourne, Australia
| | - Mark S Bleiweis
- Shands Children's Hospital, University of Florida Health, Gainesville, Florida
| | | | | | - Ari Cedars
- Children's Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sharon Chen
- Stanford Children's Health and Lucile Packard Children's Hospital, Palo Alto, California
| | | | - Kevin P Daly
- Boston Children's Hospital, Boston, Massachusetts
| | - Lara A Danziger-Isakov
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Nicole Dubyk
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Lucas Eastaugh
- The Royal Children's Hospital, Victoria Melbourne, Australia
| | | | | | - Asif Hasan
- Freeman Hospital, Newcastle upon Tyne, UK
| | - Beth Hawkins
- Boston Children's Hospital, Boston, Massachusetts
| | - Aamir Jeewa
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven J Kindel
- Department of Pediatrics, Medical College of Wisconsin and Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Winscoin
| | | | - Jodie Lantz
- Children's Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sabrina P Law
- Morgan Stanley Children's Hospital of New York Presbyterian, New York, New York
| | - Katsuhide Maeda
- Stanford Children's Health and Lucile Packard Children's Hospital, Palo Alto, California
| | - Jacob Mathew
- The Royal Children's Hospital, Victoria Melbourne, Australia
| | | | | | - Jenna Murray
- Stanford Children's Health and Lucile Packard Children's Hospital, Palo Alto, California
| | - Robert A Niebler
- Department of Pediatrics, Medical College of Wisconsin and Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Winscoin
| | | | | | - David M Peng
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Joseph Philip
- Shands Children's Hospital, University of Florida Health, Gainesville, Florida
| | | | - David N Rosenthal
- Stanford Children's Health and Lucile Packard Children's Hospital, Palo Alto, California
| | - Joseph Rossano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Kurt R Schumacher
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | | | | | - David L Sutcliffe
- Children's Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Chet Villa
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | - Farhan Zafar
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | - Matthew D Zinn
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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18
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Riggs KW, Broderick JT, Price N, Chin C, Zafar F, Morales DLS. Transplantation for Congenital Heart Disease: Focus on the Impact of Functionally Univentricular Versus Biventricular Circulation. World J Pediatr Congenit Heart Surg 2021; 12:352-359. [PMID: 33942695 DOI: 10.1177/2150135121990650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Varying single center data exist regarding the posttransplant outcomes of patients with single ventricle circulation, particularly following the Fontan operation. We sought to better elucidate these results in patients with congenital heart disease (CHD) through combining two national databases. METHODS The United Network for Organ Sharing (UNOS) transplantation database was merged with the Pediatric Health Information System (PHIS), an administrative database with 71% of UNOS patients matched. Patients undergoing transplantation at a PHIS hospital from 2006 to 2017 were categorized as single ventricle or biventricular strategy based on their diagnoses and procedures in 90% of patients. When known, single ventricle patients were further analyzed by their palliative stage post-Glenn or post-Fontan (known in 31%). RESULTS A total of 1,517 CHD transplantations were identified, 67% with single ventricle strategy (1,016). Single ventricle, biventricular, and indeterminate patients had similar survival (log-rank P > .1). Risk factors for mortality in patients with CHD were extracorporeal membrane oxygenation (ECMO) support at transplant (hazard: 2.27), ABO blood type incompatibility (hazard: 1.61), African American recipient (hazard 1.42), and liver dysfunction (hazard 1.29). A total of 130 confirmed Fontan and 185 confirmed bidirectional Glenn patients underwent transplantation, each with survival equivalent to biventricular patients (log-rank P > .500). For Fontan patients, renal dysfunction (hazard: 5.40) and transplant <1 year after Fontan (hazard 2.82) were found to be associated with mortality. CONCLUSIONS Single ventricle patients, as a group, experience similar outcomes as biventricular patients with CHD undergoing transplantation, and this extends to Fontan patients. Risk factors for mortality correlate with end-organ dysfunction as well as race and ABO blood type incompatibility in the CHD population.
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Affiliation(s)
- Kyle W Riggs
- Heart Institute, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - John T Broderick
- Heart Institute, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Nina Price
- Heart Institute, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Clifford Chin
- Heart Institute, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Farhan Zafar
- Heart Institute, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - David L S Morales
- Heart Institute, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
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19
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Systemic ventricular assist device support in Fontan patients: A report by ACTION. J Heart Lung Transplant 2021; 40:368-376. [DOI: 10.1016/j.healun.2021.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/03/2021] [Accepted: 01/13/2021] [Indexed: 12/31/2022] Open
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20
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Affiliation(s)
- Leigh Reardon
- Medicine, University of California Los Angeles, Los Angeles, California, USA.,Pediatrics, University of California Los Angeles, Los Angeles, California, USA
| | - Jeannette Lin
- Medicine, University of California Los Angeles, Los Angeles, California, USA
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21
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Monaco J, Khanna A, Khazanie P. Transplant and mechanical circulatory support in patients with adult congenital heart disease. Heart Fail Rev 2020; 25:671-683. [PMID: 32472522 PMCID: PMC7811764 DOI: 10.1007/s10741-020-09976-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Advances in surgery and pediatric care over the past decades have achieved improved survival for children born with congenital heart disease (CHD) and have produced a large, growing population of patients with adult congenital heart disease (ACHD). Heart failure has emerged as the leading cause of death and a major cause of morbidity among the ACHD population, while as little evidence supports the efficacy of guideline-directed medical therapies in this population. It is increasingly important that clinicians caring for these patients understand how to utilize mechanical circulatory support (MCS) in ACHD. In this review, we summarize the data on transplantation and MCS in the ACHD-heart failure population and provide a framework for how ACHD patients may benefit from advanced heart failure therapies like transplantation and MCS.
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Affiliation(s)
- James Monaco
- Colorado University Hospital, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
| | - Amber Khanna
- Colorado University Hospital, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Prateeti Khazanie
- Colorado University Hospital, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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22
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O'Connor MJ, Lorts A, Davies RR, Fynn-Thompson F, Joong A, Maeda K, Mascio CE, McConnell PI, Mongé MC, Nandi D, Peng DM, Rosenthal DN, Si MS, Sutcliffe DL, VanderPluym CJ, Viegas M, Zafar F, Zinn M, Morales DL. Early experience with the HeartMate 3 continuous-flow ventricular assist device in pediatric patients and patients with congenital heart disease: A multicenter registry analysis. J Heart Lung Transplant 2020; 39:573-579. [DOI: 10.1016/j.healun.2020.02.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/31/2020] [Accepted: 02/06/2020] [Indexed: 11/17/2022] Open
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23
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Smith M, El-Said H, Pretorius V, Mendenhall M, Thomas T, Reeves RR, Silva Enciso J, Alshawabkeh L, Nigro J, Adler ED, Urey MA. Significance of Aortopulmonary Collaterals in a Single-Ventricle Patient Supported With a HeartMate 3. Circ Heart Fail 2020; 13:e006473. [PMID: 32248696 DOI: 10.1161/circheartfailure.119.006473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Monica Smith
- Department of Transplant (M.S., M.M., T.T.), University of California San Diego
| | - Howaida El-Said
- Division of Pediatric Cardiology (H.E.-S.), University of California San Diego.,Division of Pediatric Cardiology (H.E.-S.), Rady Children's Hospital, San Diego, California
| | - Victor Pretorius
- Division of Cardiothoracic Surgery (V.P., J.N.), University of California San Diego
| | - Maggie Mendenhall
- Department of Transplant (M.S., M.M., T.T.), University of California San Diego
| | - Tracy Thomas
- Department of Transplant (M.S., M.M., T.T.), University of California San Diego
| | - Ryan R Reeves
- Division of Cardiovascular Medicine (R.R.R., J.S.E., L.A., E.D.A., M.A.U.), University of California San Diego
| | - Jorge Silva Enciso
- Division of Cardiovascular Medicine (R.R.R., J.S.E., L.A., E.D.A., M.A.U.), University of California San Diego
| | - Laith Alshawabkeh
- Division of Cardiovascular Medicine (R.R.R., J.S.E., L.A., E.D.A., M.A.U.), University of California San Diego
| | - John Nigro
- Division of Cardiothoracic Surgery (V.P., J.N.), University of California San Diego.,Division of Pediatric Surgery (J.N.), Rady Children's Hospital, San Diego, California
| | - Eric D Adler
- Division of Cardiovascular Medicine (R.R.R., J.S.E., L.A., E.D.A., M.A.U.), University of California San Diego
| | - Marcus A Urey
- Division of Cardiovascular Medicine (R.R.R., J.S.E., L.A., E.D.A., M.A.U.), University of California San Diego
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24
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Haranal M, Luo S, Honjo O. Mechanical Circulatory Support for Patients With Adult Congenital Heart Disease. Circ J 2020; 84:533-541. [DOI: 10.1253/circj.cj-19-0821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Maruti Haranal
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children
| | - Shuhua Luo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children
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25
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Santamaria RL, Jeewa A, Cedars A, Buchholz H, Conway J. Mechanical Circulatory Support in Pediatric and Adult Congenital Heart Disease. Can J Cardiol 2020; 36:223-233. [DOI: 10.1016/j.cjca.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 12/30/2022] Open
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26
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Villa CR, Alsaied T, Morales DLS. Ventricular Assist Device Therapy and Fontan: A Story of Supply and Demand. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2020; 23:62-68. [PMID: 32354549 DOI: 10.1053/j.pcsu.2020.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/29/2020] [Accepted: 02/26/2020] [Indexed: 06/11/2023]
Abstract
The last 10 years have seen an increase in the number of Fontan patients with heart failure. There has been a coincident rapid evolution in the field of pediatric and congenital heart disease ventricular assist device therapy. Herein, we describe the existing body of literature regarding the use of ventricular assist device therapy in the Fontan circulation as well as the current approach to clinical decision-making and device implantation within the field.
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Affiliation(s)
- Chet R Villa
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tarek Alsaied
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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27
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Ferrari MR, Di Maria MV, Jacot JG. Review on Mechanical Support and Cell-Based Therapies for the Prevention and Recovery of the Failed Fontan-Kreutzer Circulation. Front Pediatr 2020; 8:627660. [PMID: 33575233 PMCID: PMC7870783 DOI: 10.3389/fped.2020.627660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022] Open
Abstract
Though the current staged surgical strategy for palliation of single ventricle heart disease, culminating in a Fontan circulation, has increased short-term survival, mounting evidence has shown that the single ventricle, especially a morphologic right ventricle (RV), is inadequate for long-term circulatory support. In addition to high rates of ventricular failure, high central venous pressures (CVP) lead to liver fibrosis or cirrhosis, lymphatic dysfunction, kidney failure, and other comorbidities. In this review, we discuss the complications seen with Fontan physiology, including causes of ventricular and multi-organ failure. We then evaluate the clinical use, results, and limitations of long-term mechanical assist devices intended to reduce RV work and high CVP, as well as biological therapies for failed Fontan circulations. Finally, we discuss experimental tissue engineering solutions designed to prevent Fontan circulation failure and evaluate knowledge gaps and needed technology development to realize a more robust single ventricle therapy.
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Affiliation(s)
- Margaret R Ferrari
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Michael V Di Maria
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jeffrey G Jacot
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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28
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Marey G, McHugh KM, Sakhitab-Kerestes AM, Jang S, Steiner ME, John R, Richtsfeld M, Said SM, Ameduri R, Griselli M. HeartMate III as a Bridge to Transplantation in an Adolescent With Failed Fontan Circulation. JACC Case Rep 2019; 1:512-515. [PMID: 34316867 PMCID: PMC8288983 DOI: 10.1016/j.jaccas.2019.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/10/2019] [Accepted: 09/19/2019] [Indexed: 06/13/2023]
Abstract
HeartMate III is an emerging, small-sized centrifugal ventricular assist device. Its lower pump thrombosis and stroke rates make it favorable for use in pediatrics. We report the use of HeartMate III as a bridge to transplantation in an adolescent with failed Fontan circulation. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Gamal Marey
- Department of Surgery, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Kristy M. McHugh
- Department of Solid Organ Transplant, Fairview, Minneapolis, Minnesota
| | | | - Subin Jang
- Department of Surgery, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Marie E. Steiner
- Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Ranjit John
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Martina Richtsfeld
- Department of Anesthesiology, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Sameh M. Said
- Department of Surgery, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Rebecca Ameduri
- Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Massimo Griselli
- Department of Surgery, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
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29
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Shah M, Lin KY. Failure (at any stage) and the role of mechanical circulatory support in hypoplastic left heart syndrome. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.101134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Fukamachi K, Karimov JH, Miyamoto T. Challenges in pediatric mechanical circulatory support devices. Artif Organs 2019; 43:441-443. [PMID: 30900753 DOI: 10.1111/aor.13447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Kiyotaka Fukamachi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jamshid H Karimov
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Takuma Miyamoto
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
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