A novel approach to stenting a stenotic graft housing a Berlin Heart cannula by utilizing an adapted left ventricular assist device circuit

Abstract

Background A 9‐year‐old boy with Berlin Heart biventricular assist device for diagnosis of dilated cardiomyopathy developed progressive reduction in left ventricular assist device(VAD) emptying and evidence of low cardiac output despite alterations to the device settings. Computed tomography revealed that the Dacron graft attaching the systemic cannula to the ascending aorta was stenosed. Method & Result A minimally invasive approach with novel circuit modification was used to achieve antegrade stenting of the stenosed graft. Conclusion This proposed technique provides a large port for minimally invasive access via an adapted VAD circuit allowing stent insertion to the aortic graft with an excellent outcome.

Percutaneous Stenting of a Stenotic Berlin Heart Outflow Cannula Graft in a 2 Year Old Child

“…To date, only one previous report has been described in a 26 kg pediatric patient involving a hybrid approach to stenting an obstructed LVAD outflow cannula. 2 This approach included the creation of a "Y" connector to add a separate limb to the LVAD circuit to accommodate a 16-Fr Gore DrySeal sheath to the circuit for "antegrade" intervention. Additionally, The Berlin Heart was transitioned to a Levitronix LVAD system for intervention and later transitioned back to the Berlin Heart.…”

“…1 One pediatric report described outflow graft obstruction (OGO) in a 9 year-old, treated with stenting via the LVAD circuit using a hybrid approach. 2 To our knowledge, no percutaneous transcatheter intervention has been performed in a pediatric patient with LVAD OGO. We present the case of a 2 year old female with LVAD OGO treated by percutaneous stenting.…”

“Percutaneous” technique for direct external access to and stenting of obstructed pediatric ventricular assist device inflow cannula

“… 3 Although there are reports of endovascular access to and stenting of outflow VAD cannulas, interventions within inflow cannulas are rarely reported, and direct external access to the cannula has been described only once. 4 , 5 , 6 We describe a novel hybrid approach of external access to the EXCOR inflow cannula to facilitate stenting of inflow obstruction. The patient's legal guardian (mother) provided verbal consent for publication of study data; Institutional Review Board approval was not required.…”