Improved Systemic Saturation after Ventricular Assist Device Implantation in a Patient with Decompensated Dextro-Transposition of the Great Arteries after the Fontan Procedure

Abstract

We report the successful implantation of a HeartMate II left ventricular assist device after a failed Fontan procedure in a patient with dextro-transposition of the great arteries. The patient had developed significant intrapulmonary arteriovenous shunting. Despite the theoretical risk of worsening intrapulmonary shunting due to the decrease in systemic vascular resistance after device implantation, our patient did well. He was discharged from the hospital in stable condition and had better oxygen saturation than before the device was implanted. To our knowledge, ours is the 2nd report of the use of a ventricular assist device after the failure of a Fontan procedure, and the first report concerning the effect of ventricular assist device implantation on intrapulmonary shunting.

Systemic ventricular assist device support of the Fontan circulation yields promising outcomes: An analysis of The Society of Thoracic Surgeons Pedimacs and Intermacs Databases

“…6 Successful reports have spanned the full breadth of available devices and include temporary and durable support provided by continuous and pulsatile flow devices. [7][8][9][10][11][12][13][14][15][16] The patterns and outcomes of SVAD support of the Fontan circulation remain elusive in the absence of large studies.…”

Review on Mechanical Support and Cell-Based Therapies for the Prevention and Recovery of the Failed Fontan-Kreutzer Circulation

“…Data regarding the HeartMate (HM) II in a Fontan circulation is limited to case studies, lowering one patient's CVP levels by 19 mmHg ( Table 1 ) ( 56 , 59 ). The HM II has also supported young adults with a failed Fontan circulation for up 3 years before being bridged to transplantation ( 54 , 55 ). A recently published report of 35 patients with pediatric heart failure, 5 with a Fontan circulation, who received a HM III since December 2017 shows encouraging results ( Table 1 ) ( 57 , 58 ).…”

The Total Artificial Heart in End-Stage Congenital Heart Disease

“…Those patients who start to develop atrial fibrillation and early signs of renal or hepatic dysfunction are in moderate failure and can still be successfully treated with cardiac transplantation (Kanter et al, 2011 ). There is growing evidence that VAD support can be successful in a subset of these patients (Halaweish et al, 2015 ; Jabbar et al, 2015 ), however, it remains unclear when VAD implantation should be considered and what percentage of patients will benefit from systemic VAD alone. Patients with isolated, or predominant ventricular failure, are likely to benefit from VAD alone, however, Fontan failure is commonly multifactorial.…”