Ventricular assist device in univentricular heart physiology

Abstract

The use of mechanical cardiac assistance is well established as a bridge to orthotopic heart transplantation (OHT) or to recovery for patients with congestive heart failure, however, the experience in single ventricle (SV) physiology is still limited. We report two cases of mechanical assistance in patients with SV physiology: a 2-year old male with hypoplastic left heart syndrome who underwent Norwood Stage I and II followed by HF and a 4-year old female with a univentricular heart who developed a severe right ventricular dysfunction 2 years after a cavopulmonary shunt. Mechanical support utilizing ventricular assist devices (VADs) is considered a valid tool to bridge patients with congestive heart failure to either OHT or to recovery. Increasing experience and improved outcomes utilizing this technology in children with biventricular hearts have led to considering employing these devices in failing SV treatment. We present 2 cases of terminally ill children with SV who were assisted with a VAD.

The Use of Berlin Heart EXCOR VAD in Children Less than 10 kg: A Single Center Experience

“…However, because of the lack of organ donors, especially in very small children, the use of ventricular assist device (VAD) is a validated therapy to bridge patients to the OHTx with a success rate up to 84% (Ibrahim et al, 2000; Reinhartz et al, 2003; Chang and McKenzie, 2005; Stiller et al, 2005; Hetzer et al, 2006; Gandhi et al, 2008; Brancaccio et al, 2010, 2013; Potapov et al, 2011; Almond et al, 2013; Miera et al, 2014; Kirklin, 2015; Mascio, 2015; Sandica et al, 2016). …”

“…Analyzing the infant population, only the Berlin Heart EXCOR (BHE; Berlin Heart, Berlin Heart AG, Berlin, Germany) is licensed as long term VAD to bridge children to OHTx (Ibrahim et al, 2000; Reinhartz et al, 2003; Chang and McKenzie, 2005; Stiller et al, 2005; Hetzer et al, 2006; Gandhi et al, 2008; Brancaccio et al, 2010, 2013; Potapov et al, 2011; Almond et al, 2013; Miera et al, 2014). The smallest patients are particularly demanding in terms of morbidity and mortality (Ibrahim et al, 2000; Reinhartz et al, 2003; Chang and McKenzie, 2005; Stiller et al, 2005; Hetzer et al, 2006; Gandhi et al, 2008; Brancaccio et al, 2010, 2013; Potapov et al, 2011; Almond et al, 2013; Miera et al, 2014) especially now that the LVAD staying is increasing over time.…”

“…The smallest patients are particularly demanding in terms of morbidity and mortality (Ibrahim et al, 2000; Reinhartz et al, 2003; Chang and McKenzie, 2005; Stiller et al, 2005; Hetzer et al, 2006; Gandhi et al, 2008; Brancaccio et al, 2010, 2013; Potapov et al, 2011; Almond et al, 2013; Miera et al, 2014) especially now that the LVAD staying is increasing over time. In particular, small body surface area, BHE size mismatch and younger age seems to be associated with an increased risk of thromboembolic complications (Almond et al, 2013; Miera et al, 2014).…”

Right ventricular unloading and respiratory support with a wearable artificial pump-lung in an ovine model

“…For patients with end-stage left heart failure, a LVAD can provide effective circulatory support. However, the dysfunction of right side heart could be more complicated and fatal after implantation of LVAD (10, 12, 13). The total artificial pulsatile heart assist device with double chambers supplies an alternative.…”

Mechanical circulatory support for the failing functional single ventricle

“…Experience with MCS in failing FSV patients has been reported by other teams, mostly in the form of case reports (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)…”