1
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Gonzalez-Fernandez O, De Rita F, Coats L, Crossland D, Nassar MS, Hermuzi A, Santos Lopes B, Woods A, Robinson-Smith N, Petit T, Seller N, O'Sullivan J, McDiarmid A, Schueler S, Hasan A, MacGowan G, Jansen K. Ventricular assist devices in transposition and failing systemic right ventricle: role of tricuspid valve replacement. Eur J Cardiothorac Surg 2022; 62:6542520. [PMID: 35244691 DOI: 10.1093/ejcts/ezac130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/31/2022] [Accepted: 02/23/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Ventricular assist device (VAD) for systemic right ventricular (RV) failure patients post-atrial switch, for transposition of the great arteries (TGA), and those with congenitally corrected TGA has proven useful to reduce transpulmonary gradient and bridge-to-transplantation. The purpose of this study is to describe our experience of VAD in systemic RV failure and our move towards concomitant tricuspid valve replacement (TVR). METHODS This is a single-centre retrospective study of consecutive adult patients receiving HeartWare VAD for systemic RV failure between 2010 and 2019. From 2017, concomitant TVR was performed routinely. Demographic, clinical variables and echocardiographic and haemodynamic measurements pre- and post-VAD implantation were recorded. Complications on support, heart transplantation and survival rates were described. RESULTS Eighteen patients underwent VAD implantation. Moderate or severe systemic tricuspid regurgitation was present in 83.3% of patients, and subpulmonic left ventricular impairment in 88.9%. One-year survival was 72.2%. VAD implantation was technically feasible and successful in all but one. Post-VAD, transpulmonary gradient fell from 16 (15-22) to 10 (7-13) mmHg (P = 0.01). Patients with TVR (n = 6) also demonstrated a reduction in mean pulmonary and wedge pressures. Furthermore, subpulmonic left ventricular end-diastolic dimension (44.3 vs 39.6 mm; P = 0.03) and function improved in this group. After 1 year of support, 72.2% of patients were suitable for transplantation. CONCLUSIONS VAD is an effective strategy as bridge-to-candidacy and bridge-to-transplantation in patients with end-stage systemic RV failure. Concomitant TVR at the time of implant is associated with better early haemodynamic and echocardiographic results post-VAD.
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Affiliation(s)
- Oscar Gonzalez-Fernandez
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Universidad Autonoma de Madrid, Madrid, Spain
| | - Fabrizio De Rita
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Coats
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Crossland
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mohamed S Nassar
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Antony Hermuzi
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Bruno Santos Lopes
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Woods
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Robinson-Smith
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thibault Petit
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,University Hospitals Leuven, Leuven, Belgium
| | - Neil Seller
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John O'Sullivan
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Adam McDiarmid
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephan Schueler
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Asif Hasan
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Guy MacGowan
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katrijn Jansen
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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2
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Advanced Heart Failure Therapies for Adults With Congenital Heart Disease. J Am Coll Cardiol 2019; 74:2295-2312. [DOI: 10.1016/j.jacc.2019.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/20/2019] [Accepted: 09/03/2019] [Indexed: 12/15/2022]
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3
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Michel E, Orozco Hernandez E, Enter D, Monge M, Nakano J, Rich J, Anderson A, Backer C, McCarthy P, Pham D. Bridge to Transplantation With Long-Term Mechanical Assist Devices in Adults With Transposition of the Great Arteries. Artif Organs 2018; 43:90-96. [PMID: 30129258 DOI: 10.1111/aor.13347] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/07/2018] [Accepted: 08/15/2018] [Indexed: 11/30/2022]
Abstract
Prior to the widespread adoption of the arterial switch operation, patients with transposition of the great arteries (TGA) commonly underwent atrial switch operation (Mustard or Senning). It is not uncommon for these patients to progress to end stage heart failure and increasingly ventricular assist devices (VADs) are used to support these patients as a bridge to transplantation, though there is limited experience with this worldwide. A retrospective review of our institution's VAD database was undertaken and revealed seven adult patients with a history of TGA and subsequent systemic ventricular failure were implanted with a VAD: four of whom received the VAD as a bridge to transplantation (BTT) at the time of implantation, two who were initially designated as destination therapy secondary to severe pulmonary hypertension, and one who was designated as destination therapy secondary to a high risk of life-threatening non-compliance. Seven patient cases who received a VAD for severe systemic ventricular failure were included in this study. The mean age of the patients was 40 years and the majority of patients were male (6/7, 85%). Five of the patients (71.4%) had previously undergone an atrial switch operation and all of these were Mustard procedures. Two of the seven patients (28.5%) had congenitally corrected transposition of the great arteries (CC-TGA). Two of the seven patients (28.5%) had supra-systemic pulmonary pressures before VAD implantation and were designated as destination therapy (DT). One of these patients was later designated as BTT as an improvement in his pulmonary vascular resistance was observed, and subsequently underwent heart transplantation. Because of anatomic considerations, four of the patients (57%) underwent redo-sternotomy with outflow cannula anastomosis to the ascending aorta, one patient underwent VAD implantation via a left subcostal incision with anastomosis of the outflow graft to the descending thoracic aorta, and two patients (28.5%) underwent VAD implantation via a left thoracotomy and anastomosis of the outflow cannula to the descending thoracic aorta. Six of the seven patients had a HeartWare HVAD VAD implanted; one received a Thoratec Heartmate II VAD. Two patients underwent VAD explant and orthotopic heart transplant, 222 days and 444 days after VAD implant, respectively. One patient died on postoperative day 17 after complications from recurrent VAD thrombosis despite multiple pump exchanges. Four patients remain on VAD support, three of these patients are awaiting transplantation at last follow-up (mean days on support, 513 days). Bridge to transplantation with a durable VAD is technically feasible and relatively safe in patients with TGA. Multiple redo-sternotomies can be avoided with a left posterior thoracotomy approach and outflow graft anastomosis to the descending thoracic aorta after careful anatomic considerations.
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Affiliation(s)
- Eriberto Michel
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Erik Orozco Hernandez
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel Enter
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Monge
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Cardiovascular-Thoracic Surgery, Chicago, IL, USA
| | - Jota Nakano
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan Rich
- Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allen Anderson
- Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carl Backer
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Cardiovascular-Thoracic Surgery, Chicago, IL, USA
| | - Patrick McCarthy
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Duc Pham
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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4
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Saito K, Toyama H, Abe N, Sunouchi A, Ejima Y, Yamauchi M. Implantation of ventricular assist device for systemic right ventricular failure in a patient with transposition of the great arteries and post-Mustard procedure: a case report. JA Clin Rep 2018; 4:55. [PMID: 32025942 PMCID: PMC6967109 DOI: 10.1186/s40981-018-0194-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/17/2018] [Indexed: 11/24/2022] Open
Abstract
Background Ventricular assist device (VAD) is usually attached by an inflow cannula to the apex of the systemic left ventricle (LV), but very few cases with implantation of the VAD in the morphologic right ventricle (RV) have been described. Case presentation We describe the case of a 41-year-old male who developed severe systemic RV failure related to a Mustard procedure he had as an infant for treatment of TGA. His heart failure was refractory and irreversible, and therefore, he underwent VAD implantation for systemic RV support. Although the patient developed pulmonary congestion on postoperative day (POD) 5, he was discharged on POD 60. He is now looking forward to receiving heart transplantation. Conclusions Placement of a VAD for systemic RV failure could be a life-saving treatment in adult patients with heart failure due to congenital heart disease.
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Affiliation(s)
- Kazutomo Saito
- Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Hiroaki Toyama
- Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan
| | - Nozomu Abe
- Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan
| | - Azusa Sunouchi
- Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan
| | - Yutaka Ejima
- Division of Surgical Center and Supply, Sterilization, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan
| | - Masanori Yamauchi
- Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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5
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Toyama H, Takei Y, Saito K, Mori S, Ui A, Kobayashi N, Tatebe S, Adachi O, Ejima Y, Yamauchi M. Ventricular Assist Device Implantation in a Patient With Severe Systemic Right Ventricular Failure and Pulmonary Hypertension Secondary to Congenitally Corrected Transposition of Great Arteries. J Cardiothorac Vasc Anesth 2018; 32:436-440. [DOI: 10.1053/j.jvca.2017.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Indexed: 11/11/2022]
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6
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Jouan J, Grinda JM, Bricourt MO, Iserin L, Fabiani JN. Non-Pulsatile Axial flow Ventricular Assist Device for Right Systemic Ventricle failure Late after Senning Procedure. Int J Artif Organs 2018; 32:243-5. [DOI: 10.1177/039139880903200409] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac transplantation is an ever more frequent requirement for patients presenting with end-stage right systemic ventricular failure late after atrial switch operations. But as the time on the donor waiting list lengthens, the clinical conditions of these patients can easily and abruptly deteriorate, sometimes requiring systemic ventricular assistance. We document the first case of right systemic ventricular assistance with a De Bakey VAD axial pump in a patient presenting with systemic ventricular failure 23 years after procedure. He rapidly recovered total autonomy and was thus able to participate in a rehabilitation program to optimize his condition for heart transplantation.
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Affiliation(s)
- Jérôme Jouan
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris
| | - Jean-Michel Grinda
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris
| | - Marie-Odile Bricourt
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris
| | - Laurence Iserin
- Department of Cardiology, Georges Pompidou European Hospital, Paris Descartes University, Paris - France
| | - Jean-Noël Fabiani
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris
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7
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VanderPluym CJ, Cedars A, Eghtesady P, Maxwell BG, Gelow JM, Burchill LJ, Maltais S, Koehl DA, Cantor RS, Blume ED. Outcomes following implantation of mechanical circulatory support in adults with congenital heart disease: An analysis of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). J Heart Lung Transplant 2018; 37:89-99. [DOI: 10.1016/j.healun.2017.03.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 02/14/2017] [Accepted: 03/03/2017] [Indexed: 11/27/2022] Open
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8
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Steiner JM, Krieger EV, Stout KK, Stempien-Otero A, Mahr C, Mokadam NA, Hermsen JL. Durable mechanical circulatory support in teenagers and adults with congenital heart disease: A systematic review. Int J Cardiol 2017; 245:135-140. [PMID: 28781147 DOI: 10.1016/j.ijcard.2017.07.107] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/13/2017] [Accepted: 07/31/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart failure is the leading cause of morbidity and mortality for adults with congenital heart disease (ACHD). Many patients are ineligible for transplantation, and those who are eligible often face long wait times with high wait-list morbidity. Durable mechanical circulatory support (MCS) may be an option for many patients. This systematic review evaluates the published literature on the use of durable MCS in teenagers and adults with congenital heart disease. METHODS A comprehensive search of MEDLINE (PubMed), EMBASE, and the Cochrane Library was performed electronically in July 2015 and updated in March 2016, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. RESULTS Individual case reports and several case series identified 66 patients with ACHD treated with durable MCS. More than half were INTERMACS 1 or 2 at the time of implantation. Patients with Fontan repairs were more frequently classified as INTERMACS 1 or 2 (89% compared to 59% or less among other groups). Cases published after 2010 showed a trend toward less severe INTERMACS status, and patients were less likely to have received transplants by the time of reporting (31% compared to 61% prior). Durable MCS was implanted as bridge-to-transplant in 77%. Patients with Fontan repair accounted for 14% of cases. CONCLUSION Reports of durable MCS utilization in patients with ACHD are becoming more frequent and devices are being implanted in more stable patients. Reports are mostly case reports or small case series so reporting bias is likely and prospective protocoled reporting is needed.
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Affiliation(s)
- Jill M Steiner
- University of Washington, Division of Cardiology, Seattle, WA, United States.
| | - Eric V Krieger
- University of Washington, Division of Cardiology, Seattle, WA, United States; Seattle Children's Hospital, Division of Cardiology, Seattle, WA, United States
| | - Karen K Stout
- University of Washington, Division of Cardiology, Seattle, WA, United States
| | | | - Claudius Mahr
- University of Washington, Division of Cardiology, Seattle, WA, United States
| | - Nahush A Mokadam
- University of Washington, Division of Cardiothoracic Surgery, Seattle, WA, United States
| | - Joshua L Hermsen
- University of Washington, Division of Cardiothoracic Surgery, Seattle, WA, United States
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9
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3D Printing to Guide Ventricular Assist Device Placement in Adults With Congenital Heart Disease and Heart Failure. JACC-HEART FAILURE 2017; 4:301-11. [PMID: 27033018 DOI: 10.1016/j.jchf.2016.01.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/30/2015] [Accepted: 01/08/2016] [Indexed: 11/21/2022]
Abstract
As the population of adults with congenital heart disease continues to grow, so does the number of these patients with heart failure. Ventricular assist devices are underutilized in adults with congenital heart disease due to their complex anatomic arrangements and physiology. Advanced imaging techniques that may increase the utilization of mechanical circulatory support in this population must be explored. Three-dimensional printing offers individualized structural models that would enable pre-surgical planning of cannula and device placement in adults with congenital cardiac disease and heart failure who are candidates for such therapies. We present a review of relevant cardiac anomalies, cases in which such models could be utilized, and some background on the cost and procedure associated with this process.
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10
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Weis RA, Devaleria PA, Koushik S, Ramakrishna H. The increasing importance of percutaneous mechanical circulatory assist device therapy in heart failure management. Ann Card Anaesth 2015; 18:467-73. [PMID: 26440230 PMCID: PMC4881681 DOI: 10.4103/0971-9784.166441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Advances in medical and surgical care have made it possible for an increasing number of patients with Congenital Heart disease (CHD) to live into adulthood. Transposition of the great vessels (TGV) is the most common cyanotic congenital cardiac disease where the right ventricle serves as systemic ventricle. It is not uncommon for these patients to have systemic ventricular failure requiring transplantation. Study Design: Hemodynamic decompensation in these patients can be swift and difficult to manage. Increasingly percutaneous LVAD's such as the Impella (Abiomed, Mass, USA) are gaining popularity in these situations owing to their relative ease of placement, both in and outside of the operating room. Conclusion: In this paper we demonstrate that Impella (IMP) CP placement through the axillary artery approach shows to be suitable option for short term cardiac support and improvement of end organ perfusion in anticipation of cardiac transplantation.
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Affiliation(s)
| | | | | | - Harish Ramakrishna
- Department of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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11
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Menachem JN, Swaminathan AC, Bashore TM, Ward CC, Rogers JG, Milano CA, Patel CB. Initial Experience of Left Ventricular Assist Device Support for Adult Patients with Transposition of the Great Vessels. CONGENIT HEART DIS 2015; 10:382-6. [DOI: 10.1111/chd.12264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan N. Menachem
- Department of Internal Medicine; Division of Cardiology; Hospital of the University of Pennsylvania; Philadelphia Pa USA
| | - Aparna C. Swaminathan
- Department of Internal Medicine; Division of Cardiothoracic Surgery; Division of Cardiology; Duke University Medical Center; Durham NC USA
| | - Thomas M. Bashore
- Department of Internal Medicine; Division of Cardiothoracic Surgery; Division of Cardiology; Duke University Medical Center; Durham NC USA
| | - Cary C. Ward
- Department of Internal Medicine; Division of Cardiothoracic Surgery; Division of Cardiology; Duke University Medical Center; Durham NC USA
| | - Joseph G. Rogers
- Department of Internal Medicine; Division of Cardiothoracic Surgery; Division of Cardiology; Duke University Medical Center; Durham NC USA
| | - Carmelo A. Milano
- Department of Internal Medicine; Division of Cardiothoracic Surgery; Division of Cardiology; Duke University Medical Center; Durham NC USA
| | - Chetan B. Patel
- Department of Internal Medicine; Division of Cardiothoracic Surgery; Division of Cardiology; Duke University Medical Center; Durham NC USA
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12
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Jabbar AA, Franklin WJ, Simpson L, Civitello AB, Delgado RM, Frazier OH. Improved systemic saturation after ventricular assist device implantation in a patient with decompensated dextro-transposition of the great arteries after the Fontan procedure. Tex Heart Inst J 2015; 42:40-3. [PMID: 25873797 DOI: 10.14503/thij-13-3374] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We report the successful implantation of a HeartMate II left ventricular assist device after a failed Fontan procedure in a patient with dextro-transposition of the great arteries. The patient had developed significant intrapulmonary arteriovenous shunting. Despite the theoretical risk of worsening intrapulmonary shunting due to the decrease in systemic vascular resistance after device implantation, our patient did well. He was discharged from the hospital in stable condition and had better oxygen saturation than before the device was implanted. To our knowledge, ours is the 2nd report of the use of a ventricular assist device after the failure of a Fontan procedure, and the first report concerning the effect of ventricular assist device implantation on intrapulmonary shunting.
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13
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Dakkak AR, Dell'Aquila AM, Sindermann JR, Rukosujew A. Biventricular assist device implantation as bridge to transplantation after Mustard procedure. J Thorac Cardiovasc Surg 2014; 148:e243-4. [PMID: 25282661 DOI: 10.1016/j.jtcvs.2014.08.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/11/2014] [Accepted: 08/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Abdul Rahman Dakkak
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
| | - Angelo M Dell'Aquila
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Juergen R Sindermann
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Andreas Rukosujew
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
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14
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Dakkak AR, Sindermann JR, Dell'Aquila AM, Welp HA, Martens S, Scherer M. Implanting a Nonpulsatile Axial Flow Left Ventricular Assist Device as a Bridge to Transplant for Systemic Ventricular Failure After A Mustard Procedure. EXP CLIN TRANSPLANT 2014; 13:485-7. [PMID: 25232871 DOI: 10.6002/ect.2014.0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Right (systemic) ventricular failure is well described after a Mustard procedure for transposition of the great arteries. Sixty-one percent of patients have been reported to show moderate-to-severe dysfunction of the systemic ventricle, 25 years after repair of transposition of the great arteries by a Mustard procedure. In such cases, heart transplant often seems to be the only option. When severe heart failure with hemodynamic instability develops, the only way to bridge these patients to a transplant is implantation of a mechanical circulatory support system. Because of the special anatomic features of the right ventricle, the implantation procedure can be challenging. Here, we report the case of a patient who underwent a left ventricular assist device implant owing to severe heart failure, 36 years after undergoing a Mustard procedure.
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Affiliation(s)
- Abdul Rahman Dakkak
- From the Cardiothoracic Surgery, University Hospital of Muenster, Albert-Schweitzer Campus 1, Gebaeude: A1, 48149 Muenster, Germany
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15
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Mulukutla V, Franklin WJ, Villa CR, Morales DLS. Surgical device therapy for heart failure in the adult with congenital heart disease. Heart Fail Clin 2014; 10:197-206. [PMID: 24275304 DOI: 10.1016/j.hfc.2013.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Individuals with adult congenital heart disease (ACHD) are at a great risk for heart failure, and the underlying anatomic features are important predictors of heart failure. As the ACHD population grows older, multiple events, including years of an altered physiology, the neurohormonal cascade, and many still unknown, culminate in ventricular failure. Surgical device therapy is an effective method in supporting patients with heart failure. Ventricular assist devices have been used with success in bridging ACHD patients to heart transplantation or destination therapy.
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Affiliation(s)
- Venkatachalam Mulukutla
- Texas Children's Hospital, Pediatric Cardiology, 6621 Fannin Street, Houston, TX 77030, USA.
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16
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Divekar A, Horwitz P. Percutaneous mechanical circulatory support for systemic ventricular failure after the Mustard procedure. J Heart Lung Transplant 2013; 32:750-2. [PMID: 23796157 DOI: 10.1016/j.healun.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/01/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
- Abhay Divekar
- Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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Mohite PN, Popov AF, Garcia D, Hards R, Zych B, Khaghani A, Simon AR. Ventricular assist device outflow graft in congenitally corrected transposition of great arteries - a surgical challenge. J Cardiothorac Surg 2012; 7:93. [PMID: 23013548 PMCID: PMC3504508 DOI: 10.1186/1749-8090-7-93] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/22/2012] [Indexed: 01/04/2023] Open
Abstract
Congenitally corrected transposition of the great arteries is a complex congenital cardiac anomaly with a wide spectrum of morphologic features and clinical profiles. Most patients are diagnosed late in their life, undergoes surgical repairs, eventually leading to systemic ventricular failure needing heart transplant or mechanical circulatory assistance. As, aorta is located anterior to and left of the PA (Transposition of great arteries), the outflow graft of ventricular assist device traverse across pulmonary artery to reach aorta which poses challenge during further surgical explorations.
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Affiliation(s)
- Prashant N Mohite
- Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex UB9 6JH, UK.
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State-of-the-Art Implantable Cardiac Assist Device Therapy for Heart Failure: Bridge to Transplant and Destination Therapy. Clin Pharmacol Ther 2011; 91:94-100. [DOI: 10.1038/clpt.2011.274] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Joyce DL, Crow SS, John R, St. Louis JD, Braunlin EA, Pyles LA, Kofflin P, Joyce LD. Mechanical circulatory support in patients with heart failure secondary to transposition of the great arteries. J Heart Lung Transplant 2010; 29:1302-5. [DOI: 10.1016/j.healun.2010.05.030] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 05/20/2010] [Accepted: 05/30/2010] [Indexed: 11/27/2022] Open
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George RS, Birks EJ, Radley-Smith RC, Khaghani A, Yacoub M. Bridge to Transplantation With a Left Ventricular Assist Device for Systemic Ventricular Failure After Mustard Procedure. Ann Thorac Surg 2007; 83:306-8. [PMID: 17184691 DOI: 10.1016/j.athoracsur.2006.03.119] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2005] [Revised: 03/14/2006] [Accepted: 03/14/2006] [Indexed: 11/16/2022]
Abstract
After Mustard or Senning procedures, transplantation remains the only option for some patients who present at late stage with severe systemic (right) ventricular failure. In some circumstances these patients may require urgent mechanical circulatory support to bridge them to transplantation. The use of mechanical support poses considerable potential and actual specific problems both in terms of insertion and management of the device. We report the case of a 17-year-old patient who had a left ventricular assist device implanted from the right ventricle to the aorta for "end-stage" heart failure 15 years after the Mustard procedure. The specific problems are discussed and a management scheme is proposed.
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Affiliation(s)
- Robert S George
- Department of Transplantation and Mechanical Circulatory, Royal Brompton and Harefield NHS Trust, Harefield, Middlesex, United Kingdom
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