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Editorial
. 2021 Oct 19:13:194-204.
doi: 10.1016/j.xjtc.2021.09.056. eCollection 2022 Jun.

Ventricular assist device support in neonates and infants with a failing functionally univentricular circulation

Mark S Bleiweis  1 , James C Fudge  2 , Giles J Peek  1 , Himesh V Vyas  2 , Susana Cruz Beltran  3 , Andrew D Pitkin  3 , Kevin J Sullivan  3   4 , Jose F Hernandez-Rivera  4 , Joseph Philip  4 , Jeffrey P Jacobs  1
Affiliations
Editorial

Ventricular assist device support in neonates and infants with a failing functionally univentricular circulation

Mark S Bleiweis et al. JTCVS Tech. .

Abstract

Some neonates with functionally univentricular hearts are at extremely high risk for conventional surgical palliation. Primary cardiac transplantation offers the best option for survival of these challenging neonates; however, waitlist mortality must be minimized. We have developed a comprehensive strategy for the management of neonates with functionally univentricular hearts that includes the selective use of conventional neonatal palliation in standard-risk neonates, hybrid approaches in neonates with elevated risk secondary to a noncardiac etiology, and neonatal palliation combined with insertion of a single ventricular assist device (VAD) in neonates with elevated risk secondary to a cardiac etiology. Here we describe our selection criteria, technical details, management strategies, pitfalls, and current outcomes for neonates with functionally univentricular hearts supported with a VAD. Our experience shows that extremely high-risk neonates with functionally univentricular hearts who are poor candidates for conventional palliation can be successfully stabilized with concomitant palliation and pulsatile VAD insertion while awaiting cardiac transplantation.

Keywords: functionally univentricular heart; hypoplastic left heart syndrome; hypoplastic right heart syndrome; ventricular assist device.

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Figures

None
Palliation plus VAD for HRHS with a VAD and a systemic-to-pulmonary shunt with or without pulmonary arterioplasty.
Figure 1
Figure 1
Comprehensive approach to patients with hypoplastic right heart syndrome (HRHS) showing our pathway for decision making in neonates with HRHS. The pathway for the patients who are candidates for Palliation + VAD is shown in the orange boxes. VAD, Ventricular assist device.
Figure 2
Figure 2
Comprehensive approach to patients with hypoplastic left heart syndrome (HLHS), showing our pathway for decision making in neonates with HLHS. The pathway for the patients who are candidates for Hybrid + VAD is shown in the orange boxes. VAD, Ventricular assist device.
Figure 3
Figure 3
Configuration of Hybrid + VAD for hypoplastic left heart syndrome using application of bilateral pulmonary artery bands, stent placement in the patent arterial duct, atrial septectomy if needed, and Berlin Heart VAD insertion. VAD, Ventricular assist device; PA, pulmonary artery.
Figure 4
Figure 4
Configuration of Palliation + VAD for hypoplastic right heart syndrome using stent placement in the patent arterial duct, atrial septectomy if needed, and Berlin Heart VAD insertion. VAD, Ventricular assist device.
Figure 5
Figure 5
Configuration of Palliation + VAD for hypoplastic right heart syndrome using a systemic-to-pulmonary artery shunt with or without pulmonary arterioplasty, atrial septectomy if needed, and Berlin Heart VAD insertion. The systemic-to-pulmonary artery shunt may originate from the 8-mm Dacron graft extension connecting the outflow cannula to the aorta (as shown in this drawing) or from the aorta itself. VAD, Ventricular assist device.
See this image and copyright information in PMC

Comment in

  • Heart transplantation after Fontan operation.
    Konstantinov IE, Schulz A, Buratto E. Konstantinov IE, et al. JTCVS Tech. 2022 Feb 15;13:182-191. doi: 10.1016/j.xjtc.2022.01.020. eCollection 2022 Jun. JTCVS Tech. 2022. PMID: 35713585 Free PMC article. No abstract available.

References

    1. Philip J., Reyes K., Ebraheem M., Gupta D., Fudge J.C., Bleiweis M.S. Hybrid procedure with pulsatile ventricular assist device for hypoplastic left heart syndrome awaiting transplantation. J Thorac Cardiovasc Surg. 2019;158:e59–e61. - PubMed
    1. Philip J., Powers E., Machado D., Lopez Colon D., Gupta D., Shih R., et al. Pulsatile ventricular assist device as a bridge to transplant for the early high-risk single-ventricle physiology. J Thorac Cardiovasc Surg. 2021;162:405–413.e4. - PMC - PubMed
    1. Bleiweis M.S., Philip J., Peek G.J., Fudge J.C., Sullivan K.J., Co-Vu J., et al. Combined hybrid procedure and VAD insertion in 9 high-risk neonates and infants with HLHS. Ann Thorac Surg. June 26, 2021 doi: 10.1016/j.athoracsur.2021.05.073. [Epub ahead of print] - DOI - PubMed
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    1. Philip J., Gupta D., Bleiweis M.S., Pietra B.A., Vyas H.V. Hypoplastic left heart in Turner's syndrome: a primary indication for transplant? Cardiol Young. 2018;28:458–460. - PubMed

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