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Review
. 2019 Dec;27(12):590-593.
doi: 10.1007/s12471-019-01314-y.

Ventricular assist device implantation in patients with a failing systemic right ventricle: a call to expand current practice

T E Zandstra  1 , M Palmen  2 , M G Hazekamp  2 , B Meyns  3 , S L M A Beeres  1 , E R Holman  1 , P Kiès  1 , M R M Jongbloed  1   4 , H W Vliegen  1 , A D Egorova  1 , M J Schalij  1 , L F Tops  5
Affiliations
Review

Ventricular assist device implantation in patients with a failing systemic right ventricle: a call to expand current practice

T E Zandstra et al. Neth Heart J. 2019 Dec.

Abstract

Ventricular assist device (VAD) implantation is an established treatment modality for patients with end-stage heart failure, and improves symptoms and survival. In the Netherlands, it is not yet routinely considered in patients with congenital heart disease and failing systemic right ventricle (SRV). Recently, a VAD was implanted in 2 SRV patients, one who underwent a Mustard procedure during infancy for transposition of the great arteries (male, 47 years old) and one with a congenitally corrected transposition of the great arteries (male, 54 years old). The first patient is doing well >1 year after implantation; the second patient will be discharged home soon. These examples and other reports demonstrate the feasibility of adopting VAD implantation into routine care for SRV failure. In conclusion, patients with SRV failure may be suitable candidates for VAD implantation: they are relatively young, usually have a preserved subpulmonary left ventricular function, and their specific anatomical and physiological characteristics often make them unsuitable for cardiac transplantation. Therefore it is important to recognise the possibility of VAD implantation early in the process of SRV failure, and to timely refer these patients to a heart failure clinic with experience in VAD implantation in this group of patients for optimisation, screening, and implantation.

Keywords: Cardiac assist devices; Congenital; Heart defects; Heart failure.

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Conflict of interest statement

T.E. Zandstra, M.G. Hazekamp, B. Meyns, S.L.M.A. Beeres, E.R. Holman, P. Kiès, M.R.M. Jongbloed, H.W. Vliegen, A.D. Egorova and M.J. Schalij declare that they have no competing interests. M. Palmen is a proctor for Medtronic. Proctoring fees are paid to the department research fund. L.F. Tops has received a speaker fee from Medtronic.

Figures

Fig. 1
Fig. 1
Transthoracic echocardiography of patient 1 after VAD implantation 1 systemic right ventricle 2 inflow cannula 3 tricuspid valve prosthesis 4 pulmonary venous tunnel
Fig. 2
Fig. 2
Anatomy of patient 1 after VAD implantation 1 aorta 2 vena cava superior 3 pulmonary trunk 4 right superior pulmonary vein 5 right inferior pulmonary vein 6 left superior pulmonary vein 7 left inferior pulmonary vein 8 baffle 9 vena cava inferior 10 systemic right ventricle 11 subpulmonary left ventricle 12 ventricular assist device
See this image and copyright information in PMC

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