Durable Ventricular Assist Device Support for Failing Systemic Morphologic Right Ventricle: Early Results

The Fontan operation

“…Several case reports of the use of commercially available implantable left ventricular assist devices have recently been published [41][42][43]. Biomechanical engineers are developing an axial flow impeller device for cavopulmonary assist, a mechanical circulation pulsation device using shape memory alloy fiber to augment inferior vena cava (IVC) to pulmonary artery flow, and there are animal studies of the use of the Jarvik device as a right-sided pump to augment flow from the IVC to the pulmonary artery [44][45][46].…”

The Total Artificial Heart in End-Stage Congenital Heart Disease

“…The development of systemic ventricular dysfunction is reflected in the growing number of case series describing the outcome of VAD support for these patients (Joyce et al, 2010; Peng et al, 2014; Maly et al, 2015). While most centers have described morphologic right (systemic) ventricular support alone, the majority of patients will have coincident morphologic left ventricular (sub-pulmonic) dysfunction at time of surgery (Peng et al, 2014) suggesting these patients may be at risk for left (sub-pulmonic) ventricular failure and the need for possible ventricular mechanical support (Maly et al, 2015).…”

“…The development of systemic ventricular dysfunction is reflected in the growing number of case series describing the outcome of VAD support for these patients (Joyce et al, 2010; Peng et al, 2014; Maly et al, 2015). While most centers have described morphologic right (systemic) ventricular support alone, the majority of patients will have coincident morphologic left ventricular (sub-pulmonic) dysfunction at time of surgery (Peng et al, 2014) suggesting these patients may be at risk for left (sub-pulmonic) ventricular failure and the need for possible ventricular mechanical support (Maly et al, 2015). The complexity of VAD support in these patients is further increased by the potential for cannula obstruction due to right ventricular trabeculations/moderator band (Agusala et al, 2010; Joyce et al, 2010) and the frequency of clinically significant tricuspid regurgitation in these patients (Graham et al, 2000; Peng et al, 2014).…”

Ventricular Assist Devices in Patients with Systemic Right Ventricular Failure due to Congenitally Corrected Transposition of the Great Arteries

“…VADs remain the only treatment modality in patients with advanced systemic RV dysfunction and failure awaiting a donor heart, and in those who do not qualify for a surgical correction or heart transplantation. The longest reported duration of VAD support in these patients is 988 days [41][42][43][44][45][46][47]. …”

“…There have been an increasing number of case reports describing support of the systemic RV using a ventricular assist device (VAD) as a bridge to heart transplant ( Table 1) [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. Nearly all such patients presented with symptoms of advanced heart failure or pulmonary hypertension.…”