Evolution of Ventricular Assist Device Support Strategy in Children With Univentricular Physiology

Merritt, Taylor C.; Gazit, Avihu Z.; Carvajal, Horacio G.; Montgomery, Brock; Shepard, Mark; Mehegan, Mary; Canter, Matthew W.; Miller, Jacob R.; Eghtesady, Pirooz; Nath, Dilip S.

doi:10.1016/j.athoracsur.2021.09.043

Cited by 9 publications

(9 citation statements)

References 16 publications

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“…The patients with single ventricle physiology have unique anatomical configuration, etiology and mechanisms of failure, indications for mechanical circulatory support, and the type of support required, unilateral or bilateral. This makes the interpretation and the generalizability of the limited available data challenging regarding the timing and type of optimal mechanism for support (229)(230)(231)(232)(233).…”

Section: Mechanical Circulatory Supportmentioning

confidence: 99%

“…Third, the availability of three main types of support devices must be considered: (I) veno-arterial extracorporeal membrane oxygenation, ideal for shortterm support; (II) ventricular assist device, for mid and long-term support (244), either as bridge to recovery or to transplantation; (III) total artificial heart (227)(228)(229)(230)(231)(232)(236)(237)(238)(239)(240)(241)(242). When planning to use a ventricular assist device, the differences among pulsatile, axial and centrifugal pumps, having different unloading abilities, must be taken in consideration (242,245).…”

Section: Mechanical Circulatory Supportmentioning

confidence: 99%

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Narrative review of single ventricle: where are we after 40 years?

Corno¹,

Findley²,

Salazar³

2023

Transl Pediatr

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Background and Objective: Key medical and surgical advances have been made in the longitudinal management of patients with "functionally" single ventricle physiology, with the principles of Fontan circulation applied to other complex congenital heart defects. The purpose of this article is to review all of the innovations, starting from fetal life, that led to a change of strategy for single ventricle.Methods: Our literature review included all full articles published in English language on the Cochrane, MedLine, and Embase with references to "single ventricle" and "univentricular hearts", including the initial history of the treatments for this congenital heart defects as well as the innovations reported within the last decades.

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Section: Mechanical Circulatory Supportmentioning

confidence: 99%

Section: Mechanical Circulatory Supportmentioning

confidence: 99%

Narrative review of single ventricle: where are we after 40 years?

Corno¹,

Findley²,

Salazar³

2023

Transl Pediatr

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“…Further, in heart failure patients with univentricular congenital heart disease (CHD) having undergone staged palliation, there is growing use of a VAD to support patients with Glenn or Fontan circulation (Single ventricular assist device [SVAD]). [1][2][3][4][5] In these single-ventricle patients, even mild elevations in PVR are poorly tolerated. In these circumstances, elevated PVR leads to systemic venous congestion with consequences for hepatic and renal function.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Vasodilator Therapy in Pediatric Patients on Ventricular Assist Device Support: A Single-Center Experience and Proposal for Use

Schramm,

Dykes,

Hopper

et al. 2023

ASAIO Journal

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Pediatric precapillary pulmonary hypertension can develop in response to systemic atrial hypertension. Systemic atrial decompression following ventricular assist device (VAD) implantation may not sufficiently lower pulmonary vascular resistance (PVR) to consider heart transplant candidacy. Prostacyclins have been used in adult VAD patients with success, but pediatric data on safety and efficacy in this population are limited. We sought to describe our center’s experience to show its safety and to present our current protocol for perioperative use. We reviewed our use of prostacyclin therapy in pediatric patients on VAD support with high PVR from 2016 to 2021. Of the 17 patients who met inclusion, 12 survived to transplant and 1 is alive with VAD in situ. All patients survived posttransplant. With continuous intravenous (IV) epoprostenol or treprostinil therapy, there were no bleeding complications or worsening of end-organ function. A significant reduction was observed in vasoactive inotropic scores by 49% in the first 24 hours post-prostacyclin initiation. The proportion of patients surviving to transplant in this high-risk cohort is favorable. In conclusion, prostacyclins may be safe to use in patients with elevated PVR as part of their VAD and transplant course and may provide a transplant option in those otherwise not candidates.

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“…Strategies for SVAD use vary widely in the absence of established consensus, clinical criteria, or timing for implantation. 1,[6][7][8][9] Previous reports of SVAD outcomes before and after-S1P have been limited to single-center studies with ranges of on-device mortality rates from 33% to 89%. 1,7,9,10 More recently, registry reports have described increased use of SVADs with a larger subset of patients reporting successful bridge to transplant in 43-63%.…”

mentioning

confidence: 99%

“…1,[6][7][8][9] Previous reports of SVAD outcomes before and after-S1P have been limited to single-center studies with ranges of on-device mortality rates from 33% to 89%. 1,7,9,10 More recently, registry reports have described increased use of SVADs with a larger subset of patients reporting successful bridge to transplant in 43-63%. 1,2 Although these data expand on the complications of the SVAD course, there is a paucity of granular data on patient baseline pre-and post-SVAD clinical state and long-term outcomes.…”

mentioning

confidence: 99%

Single Ventricular Assist Device Care and Outcomes for Failed Stage I Palliation: A Single-Center Decade of Experience

Kulp,

Khan,

Gazit

et al. 2024

ASAIO Journal

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Single ventricular assist device (SVAD) use before and after stage I palliation (S1P) is increasing with limited data on outcomes. To address this knowledge gap, we conducted a single-center retrospective review to assess pre- and post-SVAD clinical status, complications, and outcomes. We leveraged a granular, longitudinal, local database that captures end-organ support, procedural interventions, hematologic events, laboratory data, and antithrombotic strategy. We identified 25 patients between 2013 and 2023 implanted at median age of 53 days (interquartile range [IQR] = 16–130); 80% had systemic right ventricles and underwent S1P. Median SVAD days were 54 (IQR = 29–86), and 40% were implanted directly from ECMO. Compared to preimplant, there was a significant reduction in inotrope use (p = 0.013) and improved weight gain (p = 0.008) post-SVAD. Complications were frequent including bleeding (80%), stroke (40%), acute kidney injury (AKI) (40%), infection (36%), and unanticipated catheterization (56%). Patients with in-hospital mortality had significantly more bleeding complications (p = 0.02) and were more likely to have had Blalock–Thomas–Taussig shunts pre-SVAD (p = 0.028). Survival to 1 year postexplant was 40% and included three recovered and explanted patients. At 1 year posttransplant, all survivors have technology dependence or neurologic injury. This study highlights the clinical outcomes and ongoing support required for successful SVAD use in failed single-ventricle physiology before or after S1P.

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Evolution of Ventricular Assist Device Support Strategy in Children With Univentricular Physiology

Cited by 9 publications

References 16 publications

Narrative review of single ventricle: where are we after 40 years?

Narrative review of single ventricle: where are we after 40 years?

Pulmonary Vasodilator Therapy in Pediatric Patients on Ventricular Assist Device Support: A Single-Center Experience and Proposal for Use

Single Ventricular Assist Device Care and Outcomes for Failed Stage I Palliation: A Single-Center Decade of Experience

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