Use of a ventricular assist device as a bridge to transplantation in a patient with single ventricle physiology and total cavopulmonary anastomosis

Abstract

Mechanical circulatory support can be used to manage acute and chronic cardiac failure in both adult and pediatric patients. Traditionally, extracorporeal membrane oxygenation (ECMO) has been the most common form of mechanical circulatory support in children. However, more recently, in cases of pure ventricular dysfunction, ventricular assist devices (VADs) have offered specific advantages over ECMO, including better ventricular recovery, reduced anticoagulation requirements, decreased use of blood products and decreased cost. We present the use of a VAD in an adolescent with single-ventricle physiology, who could not be weaned from cardiopulmonary bypass (CPB) after undergoing a revision of a modified Fontan operation. Gas exchange was provided by the patient's lungs while the centrifugal VAD was used successfully to support the circulation as a bridge, first to a totally implantable pulsatile VAD and subsequently to heart transplantation.