Merritt T, Gazit AZ, Carvajal H, Montgomery BK, Shepard M, Mehegan M, Canter M, Miller J, Eghtesady P, Nath DS. Evolution of Ventricular Assist Device Support Strategy in Children with Univentricular Physiology.
Ann Thorac Surg 2021;
114:1739-1744. [PMID:
34710386 DOI:
10.1016/j.athoracsur.2021.09.043]
[Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND
Since 2012, we have supported 18 children with single ventricle (SV) physiology on ventricular assist devices (VAD) as a bridge to decision, transplant, or recovery. We provide a detailed report of our cumulative surgical experience and lessons learned from these patients.
METHODS
We reviewed all SV-VADs between March 2012 and April 2020. Implanted SV-VADs intended for short-term support were excluded. Demographic and clinical data included palliation stage at the time of VAD implantation, cannulation configuration, device type, duration of support, circuit and device interventions, postoperative support, anticoagulation strategy, complications, mortality, and one-year survival post-discharge.
RESULTS
Five SV-newborns without prior surgical palliation, 8 infants post-Norwood/hybrid procedure, 4 post-Glenn, and 1 post-Fontan were initially supported with either continuous flow13/18(72%) or pulsatile flow 5/18(28%) devices. 3/18(17%) transitioned to another device during support. Before VAD conversion, 9/18(50%) were supported by extracorporeal membrane oxygenation. Outcomes include; 7/18(39%) transplanted, 2/18(11%) recovered, and 9/18(50%) died prior to discharge. Of these deaths, 2 occurred following transplant, 2 following explant and 5 had redirection of care while on support secondary to previously undiagnosed pulmonary veno-occlusive disease (n=2) or severe neurologic events (n=3). Overall, 6/18(33%) experienced neurologic injury. At last follow-up 9/18(50%) children were alive [1.2(0.8-4.3) years post-explant/transplant].
CONCLUSIONS
Our experience shows that SV children, including newborns, can be successfully bridged to desired end-points with proper patient selection and using specific cannulation strategies. Continuing utilization of this strategy is warranted for future children requiring VAD support.
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