Deipanjan Nandi1, Kelley D Miller2, Carley M Bober2, Tami M Rosenthal3, Lisa M Montenegro4, Joseph W Rossano2, J William Gaynor5, Christopher E Mascio5. 1. Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: deipanjan.nandi@nationwidechildrens.org. 2. Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 3. Department of Perfusion Services, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 4. Department of Anesthesia & Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 5. Division of Cardiothoracic Surgery, Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: Continuous-flow ventricular assist devices (CF VADs) designed for adults are increasingly used in pediatric patients. However, there is greater risk of device inflow obstruction as a result of size and anatomy. METHODS: We reviewed all cases of systemic atrioventricular valve (AVV) excision with HeartWare HVAD (HeartWare, Framingham, MA) implantation in the systemic ventricle performed at our institution from November 2015 to May 2016. RESULTS: AVV excision with CF VAD implantation was undertaken in 3 patients. Patient 1 was palliated in infancy, resulting in biventricular physiology with a systemic right ventricle, and presented at age 15 years with worsening ventricular dysfunction. After CF VAD implantation in the systemic ventricle and discharge to home, tricuspid valve obstruction to VAD inflow developed, and the patient and underwent tricuspid valve excision on postoperative day 52. Patients 2 and 3 were aged younger than 4 years, with a body surface area of 0.62 m2 and 0.58 m2, respectively, and had undergone Fontan palliation, with subsequent systemic ventricular dysfunction and AVV regurgitation. In both Fontan patients, the CF VAD was implanted in the right atrium with simultaneous excision of the AVV. None have had evidence of elevated atrial pressures or recalcitrant pulmonary edema. At a mean follow-up of 359 days (range, 304 to 422 days), there have been no concerns for inflow obstruction or low flow. CONCLUSIONS: CF VAD implantation with AVV excision can successfully support complex pediatric patients in a wide range of size and anatomy (small chambers, systemic right ventricles). This technique may allow for CF VAD implantation in patients previously deemed too small for such support.
BACKGROUND: Continuous-flow ventricular assist devices (CF VADs) designed for adults are increasingly used in pediatric patients. However, there is greater risk of device inflow obstruction as a result of size and anatomy. METHODS: We reviewed all cases of systemic atrioventricular valve (AVV) excision with HeartWare HVAD (HeartWare, Framingham, MA) implantation in the systemic ventricle performed at our institution from November 2015 to May 2016. RESULTS: AVV excision with CF VAD implantation was undertaken in 3 patients. Patient 1 was palliated in infancy, resulting in biventricular physiology with a systemic right ventricle, and presented at age 15 years with worsening ventricular dysfunction. After CF VAD implantation in the systemic ventricle and discharge to home, tricuspid valve obstruction to VAD inflow developed, and the patient and underwent tricuspid valve excision on postoperative day 52. Patients 2 and 3 were aged younger than 4 years, with a body surface area of 0.62 m2 and 0.58 m2, respectively, and had undergone Fontan palliation, with subsequent systemic ventricular dysfunction and AVV regurgitation. In both Fontan patients, the CF VAD was implanted in the right atrium with simultaneous excision of the AVV. None have had evidence of elevated atrial pressures or recalcitrant pulmonary edema. At a mean follow-up of 359 days (range, 304 to 422 days), there have been no concerns for inflow obstruction or low flow. CONCLUSIONS:CF VAD implantation with AVV excision can successfully support complex pediatric patients in a wide range of size and anatomy (small chambers, systemic right ventricles). This technique may allow for CF VAD implantation in patients previously deemed too small for such support.
Authors: Thomas Krabatsch; Alexander Stepanenko; Martin Schweiger; Marian Kukucka; Peter Ewert; Roland Hetzer; Evgenij Potapov Journal: ASAIO J Date: 2011 Jul-Aug Impact factor: 2.872
Authors: Iki Adachi; Francisco A Guzmán-Pruneda; Aamir Jeewa; Charles D Fraser; E Dean McKenzie Journal: J Heart Lung Transplant Date: 2014-09-28 Impact factor: 10.247
Authors: Oliver Miera; Richard Kirk; Holger Buchholz; Katharina R L Schmitt; Christina VanderPluym; Ivan M Rebeyka; Neil Wrightson; Felix Berger; Massimo Griselli; Jennifer Conway Journal: J Heart Lung Transplant Date: 2016-01-18 Impact factor: 10.247
Authors: John M Stulak; Vakhtang Tchantchaleishvili; Nicholas A Haglund; Mary E Davis; John A Schirger; Jennifer A Cowger; Palak Shah; Keith D Aaronson; Francis D Pagani; Simon Maltais Journal: J Heart Lung Transplant Date: 2014-12-08 Impact factor: 10.247
Authors: George J Arnaoutakis; David Blitzer; Stephanie Fuller; Aaron W Eckhauser; Lisa M Montenegro; Joseph W Rossano; J William Gaynor Journal: Ann Thorac Surg Date: 2016-07-15 Impact factor: 4.330