Use of a HeartWare Ventricular Assist Device in a Patient With Failed Fontan Circulation

Niebler, Robert A.; Ghanayem, Nancy S.; Shah, Tejas; Bobke, Andrea De La Rosa; Zangwill, Steven; Brosig, Cheryl L.; Frommelt, Michelle A.; Mitchell, Michael E.; Tweddell, James S.; Woods, Ronald K.

doi:10.1016/j.athoracsur.2013.11.075

Cited by 57 publications

(36 citation statements)

References 7 publications

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“…Hoganson et al [21] reported successful bridge-toheart transplantation using a Berlin Heart VAD in a child. Niebler et al [22] presented a successful case of using a HeartWare VAD as a bridge to transplantation. However, in these reports, VAD was used as systemic circulatory assist.…”

Section: Discussionmentioning

confidence: 98%

Partial cavopulmonary assist from the inferior vena cava to the pulmonary artery improves hemodynamics in failing Fontan circulation: a theoretical analysis

et al. 2015

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Cavopulmonary assist (CPA) for failing Fontan patients remains a challenging issue in the clinical setting. To evaluate the effectiveness of a partial CPA from the inferior vena cava (IVC) to the pulmonary artery (PA), we performed a theoretical analysis using a computational model of the Fontan circulation. Cardiac chambers and vascular systems were described as the time-varying elastance model and the modified three-element Windkessel model, respectively. A rotational pump described as a non-linear function was inserted between the IVC and the PA. When pulmonary vascular resistance index varied from 2.1 to 5.9 Wood units m(2), the partial CPA maintained cardiac index as efficiently as total CPA and markedly reduced the IVC pressure compared with total CPA. However, the partial CPA increased the superior vena cava pressure substantially. The modification from total to partial CPA is potentially an effective alternative in failing Fontan patients suffering from high IVC pressure.

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Section: Discussionmentioning

confidence: 98%

Partial cavopulmonary assist from the inferior vena cava to the pulmonary artery improves hemodynamics in failing Fontan circulation: a theoretical analysis

et al. 2015

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“…One patient (11.1%) had aortic regurgitation. The LV median ejection fraction was 20% (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Eight patients (88.8%) needed inotropic support prior to HeartWare implantation, usually milrinone, dobutamine, and epinephrine.…”

Section: Patientsmentioning

confidence: 99%

Long‐Term Mechanical Circulatory Support in Pediatric Patients

et al. 2015

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This retrospective study reviews our results regarding the long-term support in pediatric patients using two ventricular assist systems between January 2008 and April 2014. We implanted the Berlin Heart EXCOR in 29 patients (median age 3.4 years [interquartile range (IQR) 0.2-16.5], median weight 13 kg [IQR 4.2-67.2]). Twenty-two patients (75.8%) received a left ventricular assist device. Three patients (10.3%) had single-ventricle physiology. One patient (3.4%) had mechanical mitral valve prosthesis. The HeartWare System was implanted in nine patients. The median age was 15.6 years (IQR 12.2-17.9), and the median weight was 54.9 kg (IQR 27.7-66). In the Berlin Heart group, the median support time was 65 days (IQR 4-619), with 3647 days of cardiac support. Nineteen patients (65.5%) were transplanted, six patients (20.7%) recovered, one patient (3.4%) is on support, and three patients (10.3%) died on support. Survival rate was 89.7%. Fourteen blood pumps had been exchanged. Four patients (13.8%) had local signs of infection, and three patients (10.3%) had neurological complications. In the HeartWare group, the median support time was 180 days (IQR 1-1124), with 2839 days of cardiac support. Four patients (44.4%) had local signs of infection, and three (33.3%) had neurological complications. Eight patients (88.9%) have been transplanted, and one patient (11.1%) died on support. Survival rate was 88.9%. Excellent survival is possible after long-term mechanical circulatory support in patients with two- and single-ventricle physiology with a low rate of adverse events.

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“…Centrifugal pumps transfer kinetic energy into the blood using impeller blades to create centrifugal acceleration and a pressure gradient across the pump, negatively pressurizing the pre-pump tubing (8). There is a current trend to use centrifugal pumps in ECLS circuits.…”

Section: Potential Danger Of Pre-pump Clamping On Negative Pressure-amentioning

confidence: 99%

Early Outcomes With HeartWare HVAD as Bridge to Transplant in Children: A Single Institution Experience

et al. 2015

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The HeartWare HVAD has been used as a bridge to cardiac transplantation in the pediatric population. We describe outcomes following HeartWare HVAD implantation at a single center. A retrospective chart review was performed of all HeartWare HVAD implants performed at our institution between May 2013 and March 2015. Eight children between the ages of 9 and 17 years underwent HVAD implantation as a bridge to transplant (N = 7 cardiomyopathy, N = 1 complex single ventricle). There was one operative death in the complex single ventricle patient. Seven patients (87%) were successfully bridged to transplant. Median time of support was 24.5 days (range, 6-91 days). All transplanted patients are alive and well at a median follow-up of 448 days. Our results demonstrated that mechanical support with HeartWare HVAD is feasible in patients of varying sizes (from older children to adolescents).

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Use of a HeartWare Ventricular Assist Device in a Patient With Failed Fontan Circulation

Cited by 57 publications

References 7 publications

Partial cavopulmonary assist from the inferior vena cava to the pulmonary artery improves hemodynamics in failing Fontan circulation: a theoretical analysis

Partial cavopulmonary assist from the inferior vena cava to the pulmonary artery improves hemodynamics in failing Fontan circulation: a theoretical analysis

Long‐Term Mechanical Circulatory Support in Pediatric Patients

Early Outcomes With HeartWare HVAD as Bridge to Transplant in Children: A Single Institution Experience

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