Use of Hemodynamic Ramp Study to Optimize Continuous-Flow Ventricular Assist Device in a Fontan Patient

Abstract

The utility of hemodynamic ramp studies in single ventricle patients supported by continuous flow left ventricular assist devices (CF-LVADs) is largely unknown. We report the novel use of the hemodynamic ramp test to optimize a 26 year-old Fontan-palliated single-ventricle patient supported with a continuous-flow ventricular assist device (Heartware HVAD). Modest improvements in Fontan hemodynamics resulted in significant and persistent clinical improvement and symptomatic relief.

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

“…Given donor shortage, there are many reports in recent years (2014-2019) of SVAD support for Fontan patients as BTT. 42,180,184,[193][194][195][196][197][198][199][200][201][202][203] There are also case reports of DT SVAD support for Fontan patients, 204 as well as VAD support of the pulmonary circulation. 205 Additionally, SVAD support in Fontan patients as bridge to combined multiorgan (heart-liver, heart-kidney) transplant have not yet been reported.…”

“…Durable CF 184,[193][194][195][196][197][198]204 and PF devices, 180,[198][199][200][201] as well as temporary support devices, 202 have been used in Fontan patients as BTT. Recently, there has been increasing use of durable CF devices including the HeartMate 3 197 and HVAD.…”

“…Recently, there has been increasing use of durable CF devices including the HeartMate 3 197 and HVAD. 184,[193][194][195][196]198,204 PF devices (EXCOR) should be considered for patients who cannot receive a durable CF device (typically due to size). 180,[198][199][200][201] Right and left sided ("biventricular") support has been reported using the TAH 42 or BiVAD support (with EXCOR 199 or HVAD 194 ).…”