Chin L Poh1,2,3, Roberto Chiletti4, Diana Zannino5, Christian Brizard1,2,3, Igor E Konstantinov1,2,3, Stephen Horton6, Johnny Millar4, Yves d'Udekem1,2,3. 1. Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia. 2. Heart Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia. 3. Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia. 4. Department of Paediatric Intensive Care, The Royal Children's Hospital, Melbourne, Victoria, Australia. 5. Department of Clinical Epidemiology & Biostatistics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia. 6. Department of Cardiac Surgery (Perfusion), The Royal Children's Hospital, Melbourne, Victoria, Australia.
Abstract
OBJECTIVES: The capacity and limitations of ventricular assist device (VAD) support in single-ventricle physiology remains poorly understood. We aimed to review our experience in the use of VAD support in the single-ventricle circulation to determine its feasibility in this population. METHODS: We reviewed our experience with VAD support in patients with single ventricles over the past 25 years. Fifty-seven patients received 64 runs of VAD support between 1990 and 2015 at a median age of 13 days [interquartile range (IQR) 4.1-99.4 days], of which 55 were supported for post-cardiotomy failure. The majority of patients received short-term VAD support, while 4 patients were either directly supported (1) or transitioned onto the Berlin Heart EXCOR (3). RESULTS: The median duration of support was 3.5 days (IQR 2.8-5.2 days). Twelve patients suffered significant neurological complications, and thromboembolic events occurred in 8 patients. Twenty-nine of the 55 patients were successfully weaned off support (53%). There were 37 inpatient deaths, with a survival-to-hospital discharge rate of 33% (18 of 55). Of the 4 patients supported after early Fontan failure, 3 died. Having a higher mean arterial blood pressure on initiation of VAD support was the only significant predictor of death (hazards ratio 1.08; 95% confidence interval 1.03-1.14; P = 0.002). Patients who required a second run of support had higher hospital mortality (83% vs 63%; P = 0.84). Of the hospital survivors, 12 patients (63%) remain alive without heart transplantation at median 7.2 years (IQR 3.5-14.0) post VAD support. CONCLUSIONS: VAD support in patients with a single ventricle has a high hospital mortality, with 1 of 3 patients surviving to discharge. Systemic VAD support is likely futile in the setting of early Fontan failure or when re-initiation of support is required.
OBJECTIVES: The capacity and limitations of ventricular assist device (VAD) support in single-ventricle physiology remains poorly understood. We aimed to review our experience in the use of VAD support in the single-ventricle circulation to determine its feasibility in this population. METHODS: We reviewed our experience with VAD support in patients with single ventricles over the past 25 years. Fifty-seven patients received 64 runs of VAD support between 1990 and 2015 at a median age of 13 days [interquartile range (IQR) 4.1-99.4 days], of which 55 were supported for post-cardiotomy failure. The majority of patients received short-term VAD support, while 4 patients were either directly supported (1) or transitioned onto the Berlin Heart EXCOR (3). RESULTS: The median duration of support was 3.5 days (IQR 2.8-5.2 days). Twelve patients suffered significant neurological complications, and thromboembolic events occurred in 8 patients. Twenty-nine of the 55 patients were successfully weaned off support (53%). There were 37 inpatient deaths, with a survival-to-hospital discharge rate of 33% (18 of 55). Of the 4 patients supported after early Fontan failure, 3 died. Having a higher mean arterial blood pressure on initiation of VAD support was the only significant predictor of death (hazards ratio 1.08; 95% confidence interval 1.03-1.14; P = 0.002). Patients who required a second run of support had higher hospital mortality (83% vs 63%; P = 0.84). Of the hospital survivors, 12 patients (63%) remain alive without heart transplantation at median 7.2 years (IQR 3.5-14.0) post VAD support. CONCLUSIONS: VAD support in patients with a single ventricle has a high hospital mortality, with 1 of 3 patients surviving to discharge. Systemic VAD support is likely futile in the setting of early Fontan failure or when re-initiation of support is required.
Authors: Javier J Lasa; Michael Gaies; Lauren Bush; Wenying Zhang; Mousumi Banerjee; Jeffrey A Alten; Ryan J Butts; Antonio G Cabrera; Paul A Checchia; Justin Elhoff; Angela Lorts; Joseph W Rossano; Kurt Schumacher; Lara S Shekerdemian; Jack F Price Journal: Circ Heart Fail Date: 2020-04-17 Impact factor: 8.790
Authors: Evgenij V Potapov; Christiaan Antonides; Maria G Crespo-Leiro; Alain Combes; Gloria Färber; Margaret M Hannan; Marian Kukucka; Nicolaas de Jonge; Antonio Loforte; Lars H Lund; Paul Mohacsi; Michiel Morshuis; Ivan Netuka; Mustafa Özbaran; Federico Pappalardo; Anna Mara Scandroglio; Martin Schweiger; Steven Tsui; Daniel Zimpfer; Finn Gustafsson Journal: Eur J Cardiothorac Surg Date: 2019-08-01 Impact factor: 4.191