Palliation Plus Ventricular Assist Device Insertion in 15 Neonates and Infants With Functionally Univentricular Circulation

Bleiweis, Mark S.; Philip, Joseph; Peek, Giles; Fudge, James C.; Sullivan, Kevin; Co-Vu, Jennifer; Gupta, Dipankar; Shih, Renata; Pietra, Biagio; Fricker, Frederick J.; Vyas, Himesh V.; Hernandez-Rivera, Jose F.; Powers, Emma; Nixon, Connie S.; Falasa, Matheus P.; Jacobs, Jeffrey P.

doi:10.1016/j.athoracsur.2022.02.051

Cited by 15 publications

(25 citation statements)

References 11 publications

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“…In patients with functionally univentricular hearts, we prefer pulsatile VAD rather than continuous-flow VAD [7][8][9][10][11][12][13] because we believe that:…”

Section: Discussionmentioning

confidence: 99%

“…Because of these potentially long waiting times, it is also reasonable to stabilize these high-risk patients with functionally univentricular hearts with VAD while awaiting transplantation. [7][8][9][10][11][12][13] This approach facilitates early extubation and optimization for transplantation while on VAD in this high-risk population. [7][8][9][10][11][12][13] In very high-risk patients with functionally univentricular circulation, primary transplantation can be considered rather than surgical palliation [7][8][9][10][11][12][13] because rescue transplantation after failed surgical palliation is associated with worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13] This approach facilitates early extubation and optimization for transplantation while on VAD in this high-risk population. [7][8][9][10][11][12][13] In very high-risk patients with functionally univentricular circulation, primary transplantation can be considered rather than surgical palliation [7][8][9][10][11][12][13] because rescue transplantation after failed surgical palliation is associated with worse outcomes. [15][16][17][18][19][20] Survival after transplantation for HLHS or HLHS-related malformations is better with primary transplantation in comparison to transplantation after previous cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Of 11 patients with HRHS or HRHS-related malformations with ductal-dependent pulmonary circulation, seven high-risk patients with pulmonary atresia and intact ventricular septum (PA-IVS) underwent primary palliation + sVAD insertion without prior cardiac surgery; detailed analyses of the first six of these patients have been published, 11 and one additional patient with PA-IVS has been managed with this approach since that time. The remaining four patients with HRHS or HRHS-related malformations with ductal-dependent pulmonary circulation underwent VAD insertion after having undergone:…”

Section: Materials and Methods Patientsmentioning

confidence: 99%

“…[1][2][3][4][5][6] Over the past four years, our program has published a series of manuscripts describing our evolving approach to providing support with a "Single Ventricle-Ventricular Assist Device" (sVAD) to patients with functionally univentricular circulation. [7][8][9][10][11][12][13] These seven previous publications describe the evolving details of our techniques for preemptive sVAD utilization in functionally univentricular neonates with unfavorable cardiac anatomy and extreme risk of cardiac compromise before or during staged palliation, who have either ductaldependent pulmonary circulation or ductal-dependent systemic circulation. Neonates with functionally univentricular ductal-dependent pulmonary circulation undergo combined palliation + sVAD insertion, while neonates with functionally univentricular ductal-dependent systemic circulation undergo combined hybrid + sVAD insertion.…”

Section: Introductionmentioning

confidence: 99%

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A Single-Institutional Experience with 36 Children Smaller Than 5 Kilograms Supported with the Berlin Heart Ventricular Assist Device (VAD) over 12 Years: Comparison of Patients with Biventricular versus Functionally Univentricular Circulation

Bleiweis

Philip

Peek

et al. 2023

World J Pediatr Congenit Heart Surg

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Objectives We reviewed outcomes in all 36 consecutive children <5 kg supported with the Berlin Heart pulsatile ventricular assist device (VAD) at the University of Florida, comparing those with univentricular circulation (n = 23) with those with biventricular circulation (n = 13). Methods The primary outcome was mortality. Kaplan-Meier methods and log-rank tests were used to assess group differences in long-term survival after VAD insertion. T-tests using estimated survival proportions and standard errors were used to compare groups at specific time points. Results Of all 82 patients ever supported with Berlin Heart at our institution, 49 (49/82 = 59.76%) weighed <10 kg and 36 (36/82 = 43.90%) weighed <5 kg. Of these 36 patients who weighed <5 kg, 26 (26/36 = 72.22%) were successfully bridged to transplantation. Of these 36 patients who weighed <5 kg, 13 (13/36 = 36.1%) had biventricular circulation and were supported with 12 BiVAD and 1 LVAD (Age [days]: median = 67, range = 17–212; Weight [kilograms]: median = 4.1, range = 3.1–4.9), while 23 (23/36 = 63.9%) had univentricular circulation and were supported with 23 sVAD (Age [days]: median = 25, range = 4–215; Weight [kilograms]: median = 3.4, range = 2.4–4.9). Of 13 biventricular patients who weighed <5 kg, 12 (12/23 = 92.3%) were successfully bridged to cardiac transplantation. Of 23 functionally univentricular patients who weighed <5 kg, 14 (14/23 = 60.87%) were successfully bridged to cardiac transplantation. For all 36 patients who weighed <5 kg: 1-year survival estimate after VAD insertion = 62.7% (95% confidence interval [CI] = 48.5%-81.2%) and 5-year survival estimate after VAD insertion = 58.5% (95% CI = 43.8%-78.3%). One-year survival after VAD insertion: 84.6% (95% CI = 67.1%-99.9%) in biventricular patients and 49.7% (95% CI = 32.3%-76.4%) in univentricular patients, P = 0.018. Three-year survival after VAD insertion: 84.6% (95% CI = 67.1%-99.9%) in biventricular patients and 41.4% (95% CI = 23.6%-72.5%) in univentricular patients, P = 0.005. Conclusion Pulsatile VAD facilitates bridge to transplantation in neonates and infants weighing <5 kg; however, survival after VAD insertion in these small patients is less in those with univentricular circulation in comparison with those with biventricular circulation.

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“…In patients with functionally univentricular hearts, we prefer pulsatile VAD rather than continuous-flow VAD [7][8][9][10][11][12][13] because we believe that:…”

Section: Discussionmentioning

confidence: 99%