A Novel Surgical Approach to Mechanical Circulatory Support in Univentricular Infants

Gazit, Avihu Z.; Petrucci, Orlando; Manning, Peter B.; Shepard, Mark; Baltagi, Sirine; Simpson, Kathleen E.; Castleberry, Chesney; Canter, Charles; Eghtesady, Pirooz

doi:10.1016/j.athoracsur.2017.04.023

Cited by 26 publications

(26 citation statements)

References 14 publications

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“…Recently there has been an increasing number of mechanical devices available for the surgeons, however MCS in SV failure is centered only on few of those, as reported by the literature (9, 30, 53). Centrifugal pumps can be used with an oxygenator as VA-ECMO or without as a VAD, either as a UVAD leaving the mBTs, the SCPC, or the TCPC as a source of pulmonary blood flow, or as a BiVAD after recreating a venous reservoir for systemic venous drainage (9).…”

Section: Discussionmentioning

confidence: 99%

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Mechanical Circulatory Support for Single Ventricle Failure

Griselli

Sinha

Jang

et al. 2018

Front. Cardiovasc. Med.

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Mechanical circulatory support (MCS) for failing single ventricle (SV) physiology is a complex and challenging problem, which has not yet been satisfactorily addressed. Advancements in surgical strategies and techniques along with intensive care management have substantially improved the outcomes of neonatal palliation for SV physiology, particularly for hypoplastic left heart syndrome (HLHS). This is associated with a steady increase in the number of SV patients who are susceptible to develop heart failure (HF) and would potentially require MCS at a certain stage in their palliation. We have reviewed the literature regarding the reported modalities of MCS use in the management of SV patients. This includes analysis of various devices and strategies used for failing circulation at distinct stages of the SV pathway: after neonatal palliation, after the superior cavo-pulmonary connection (SCPC), and after total cavo-pulmonary connection (TCPC).

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Section: Discussionmentioning

confidence: 99%

“…The benefit of this technique is conferred by the improved stability of the BHE cannulae compared with routine ECMO cannulae placement. Seven patients were treated with this novel technique with 3 patients (43%) being discharged home, two after SCPC and one after OHTx (30). …”

Section: Mechanical Circulatory Support Typementioning

confidence: 99%

Mechanical Circulatory Support for Single Ventricle Failure

Griselli

Sinha

Jang

et al. 2018

Front. Cardiovasc. Med.

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“…[174][175][176] There is increasing use of the paracorporeal CF devices with more durable cannulation in this population. [175][176][177][178] Inflow cannula is typically placed in the common atrium post atrial septectomy and the outflow cannula is placed into the ascending neoaorta post Norwood operation 174,175 or pulmonary artery after hybrid palliation (which may require graft extension) in HLHS. 174,177 The outflow cannula is placed in the aorta in PA/IVS both prior to or after shunt placement.…”

Section: Support Strategies For Single Ventricle Patientsmentioning

confidence: 99%

ISHLT consensus statement for the selection and management of pediatric and congenital heart disease patients on ventricular assist devices Endorsed by the American Heart Association

Lorts

Conway

Schweiger

et al. 2021

The Journal of Heart and Lung Transplantation

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“…However, once it is determined that there is no pulmonary pathology, the patient should be converted to a VAD to allow for recovery or BTT. Specifically, we attempt to avoid the use of an oxygenator whenever possible (45).…”

Section: Device Typementioning

confidence: 99%

“…If the patient has a Sano shunt, this is taken down. To provide pulmonary flow, either a BT shunt is created or the proximal end of the Sano shunt is anastomosed end-to-side to the outflow cannula via the homograft or Gore-Tex extension (45).…”

Section: Configurationmentioning

confidence: 99%

An overview of mechanical circulatory support in single-ventricle patients

et al. 2018

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The population of people with a single-ventricle is continually increasing due to improvements across the spectrum of medical care. Unfortunately, a proportion of these patients will develop heart failure.Often, for these patients, mechanical circulatory support (MCS) represents the only available treatment option. While single-ventricle patients currently represent a small proportion of the total number of patients who receive MCS, as the single-ventricle patient population increases, this number will increase as well.Outcomes for these complex single-ventricle patients who require MCS has begun to be evaluated. When considering the entire population, survival to hospital discharge is 30-50%, though this must be considered with the significant heterogeneity of the single-ventricle patient population. Patients with a single-ventricle have unique anatomy, mechanisms of failure, indications for MCS and the type of support utilized. This has made the interpretation and the generalizability of the limited available data difficult. It is likely that some subsets will have a significantly worse prognosis and others a better one. Unfortunately, with these limited data, indications of a favorable or poor outcome have not yet been elucidated. Though currently, a database has been constructed to address this issue. While the outcomes for these complex patients is unclear, at least in some situations, they are poor. However, significant advances may provide improvements going forward, including new devices, computer simulations and 3D printed models. The most important factor, however, will be the increased experience gained by the heart failure team to improve patient selection, timing, device and configuration selection and operative approach.

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A Novel Surgical Approach to Mechanical Circulatory Support in Univentricular Infants

Cited by 26 publications

References 14 publications

Mechanical Circulatory Support for Single Ventricle Failure

Mechanical Circulatory Support for Single Ventricle Failure

ISHLT consensus statement for the selection and management of pediatric and congenital heart disease patients on ventricular assist devices Endorsed by the American Heart Association

An overview of mechanical circulatory support in single-ventricle patients

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