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Alonso-Gonzalez R, Agorrody G. Special Considerations for Mechanical Circulatory Support or Device Therapy in Adult Congenital Heart Disease Heart Failure. Heart Fail Clin 2024; 20:155-165. [PMID: 38462320 DOI: 10.1016/j.hfc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Heart failure has become the leading cause of mortality in adult congenital heart disease (ACHD) patients after the fifth decade of life. There is scanty evidence supporting the use of guideline-directed medical therapy in ACHD, especially in systemic right ventricle or single ventricle physiology. In complex patients, diagnosing heart failure and timely referral for advanced therapies are challenging. Mechanical circulatory support has been significantly developed over the past decade and has recently emerged as a feasible therapeutic option for these patients. This review summarizes current evidence of mechanical circulatory support in this population, its potential uses, and challenges.
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Affiliation(s)
- Rafael Alonso-Gonzalez
- Toronto ACHD Program, Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Avenue, 5N-525, Toronto, Ontario, M5G 2N2, Canada.
| | - Guillermo Agorrody
- Toronto ACHD Program, Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Avenue, 5N-525, Toronto, Ontario, M5G 2N2, Canada
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Rali AS, Garry JD, Dieter RA, Schlendorf KH, Bacchetta MD, Zalawadiya SK, Mishra K, Trahanas J, Frischhertz BP, Lindenfeld J, Olson TL, Cedars AM, Anders MM, Tonna JE, Dolgner SJ, Alvis BD, Menachem JN. Extracorporeal Life Support for Cardiogenic Shock in Adult Congenital Heart Disease-An ELSO Registry Analysis. ASAIO J 2023; 69:984-992. [PMID: 37549669 DOI: 10.1097/mat.0000000000002026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
There are minimal data on the use of venoarterial extracorporeal membrane life support (VA-ECLS) in adult congenital heart disease (ACHD) patients presenting with cardiogenic shock (CS). This study sought to describe the population of ACHD patients with CS who received VA-ECLS in the Extracorporeal Life Support Organization (ELSO) Registry. This was a retrospective analysis of adult patients with diagnoses of ACHD and CS in ELSO from 2009-2021. Anatomic complexity was categorized using the American College of Cardiology/American Heart Association 2018 guidelines. We described patient characteristics, complications, and outcomes, as well as trends in mortality and VA-ECLS utilization. Of 528 patients who met inclusion criteria, there were 32 patients with high-complexity anatomy, 196 with moderate-complexity anatomy, and 300 with low-complexity anatomy. The median age was 59.6 years (interquartile range, 45.8-68.2). The number of VA-ECLS implants increased from five implants in 2010 to 81 implants in 2021. Overall mortality was 58.3% and decreased year-by-year (β= -2.03 [95% confidence interval, -3.36 to -0.70], p = 0.007). Six patients (1.1%) were bridged to heart transplantation and 21 (4.0%) to durable ventricular assist device. Complications included cardiac arrhythmia/tamponade (21.6%), surgical site bleeding (17.6%), cannula site bleeding (11.4%), limb ischemia (7.4%), and stroke (8.7%). Utilization of VA-ECLS for CS in ACHD patients has increased over time with a trend toward improvement in survival to discharge.
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Affiliation(s)
- Aniket S Rali
- From the Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonah D Garry
- From the Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Raymond A Dieter
- From the Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelly H Schlendorf
- From the Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew D Bacchetta
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandip K Zalawadiya
- From the Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelly Mishra
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John Trahanas
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Benjamin P Frischhertz
- From the Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joann Lindenfeld
- From the Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Taylor L Olson
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia
| | - Ari M Cedars
- Division of Cardiovascular Medicine, The John Hopkins Hospital, Baltimore, Maryland
| | - Marc M Anders
- Division of Critical Care, Texas Children's Hospital, Houston, Texas
- Division of Critical Care, Baylor College of Medicine, Houston, Texas
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery and Department of Emergency Medicine, University of Utah Health, Salt Lake City, Utah
| | - Steven J Dolgner
- Division of Critical Care, Texas Children's Hospital, Houston, Texas
| | - Bret D Alvis
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan N Menachem
- From the Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
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Shekhar S, Agrawal A, Pampori A, Lak H, Windsor J, Ramakrishna H. Mortality in Adult Congenital Heart Disease: Analysis of Outcomes and Risk Stratification. J Cardiothorac Vasc Anesth 2022; 36:3379-3388. [DOI: 10.1053/j.jvca.2022.03.010] [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] [Received: 03/06/2022] [Accepted: 03/10/2022] [Indexed: 11/11/2022]
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