Mechanically assisted Fontan completion: A new approach for the failing Glenn circulation due to isolated ventricular dysfunction

Adachi, Iki; Williams, Eric A.; Jeewa, Aamir; Elias, Barbara; McKenzie, E. Dean

doi:10.1016/j.healun.2016.09.011

Cited by 32 publications

(33 citation statements)

References 5 publications

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“…Given the superior outcomes in Stage 3 patients, Stage 2 patients with severe systolic dysfunction should be considered for concomitant Fontan operation and VAD implantation (i.e., "mechanically assisted Fontan completion"), which has been reported previously. 15 Further study is warranted to determine whether this approach can improve VAD outcomes for Stage 2 patients.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of children with congenital heart disease implanted with ventricular assist devices: An analysis of the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs)

Peng

Koehl

Cantor

et al. 2019

The Journal of Heart and Lung Transplantation

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BACKGROUND: The reported ventricular assist device (VAD) experience in the pediatric congenital heart disease (CHD) population is limited. We sought to describe contemporary use and outcomes of VADs in children with CHD and compare these outcomes to those of non-CHD children. METHODS: Patients enrolled in the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) between September 19, 2012 through June 30, 2017 were included. CHD was classified as biventricular vs single ventricle (Stages 1, 2, or 3). Outcomes were compared between groups and multivariable analysis was used to identify factors associated with mortality on the device. RESULTS: Among the 471 patients enrolled, 108 (24%) had CHD (45 biventricular and 63 single ventricle). CHD patients were younger (5.7 § 5.7 years vs 9.8 § 6.5 years; p < 0.0001) and smaller (0.8 § 0.5 m 2 vs 1.2 § 0.7 m 2 ; p < 0.0001) compared with non-CHD patients. CHD patients were more likely to receive a paracorporeal continuous-flow VAD (36.1% vs 12.9%; p < 0.0001) and less likely to receive an implantable continuous-flow VAD (27.8% vs 55.0%; p < 0.0001) compared with non-CHD patients. After 6 months on a VAD, CHD patients had higher mortality (36.4% vs 12.1%) and a lower transplantation rate (29.1% vs 59.9%) than non-CHD patients (p < 0.0001). In the multivariable analysis, CHD was the factor most strongly associated with mortality on VAD (hazard ratio [HR] = 2.9; p < 0.0001), whereas the factors implantable continuous-flow device and high-volume center were protective (HR = 0.3, p < 0.0001, and HR = 0.6, respectively; p = 0.02). CONCLUSIONS: VAD use in children with CHD is associated with increased mortality and decreased transplant rates compared to children without CHD. For the subgroup of children with

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Section: Discussionmentioning

confidence: 99%

Outcomes of children with congenital heart disease implanted with ventricular assist devices: An analysis of the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs)

Peng

Koehl

Cantor

et al. 2019

The Journal of Heart and Lung Transplantation

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“…Although VAD support in Glenn patients remains challenging with high mortality rates, published experience indicates that successful outcomes are more likely in older patients and those >10 kg . Recent successful strategies include both pulsatile and CF pumps, systemic ventricle or atrial inflow cannulation with ascending aorta outflow cannulation, Glenn takedown to a systemic pulmonary shunt (Figure ) or conversion to a Fontan circulation at the time of VAD implantation …”

Section: Ventricular Assist Devices For the Failing Single Ventriclementioning

confidence: 99%

“…27 Recent successful strategies include both pulsatile and CF pumps, systemic ventricle or atrial inflow cannulation with ascending aorta outflow cannulation, Glenn takedown to a systemic pulmonary shunt ( Figure 5) or conversion to a Fontan circulation at the time of VAD implantation. 28 may be required with ventricular cannulation but there is a risk of suck down events because of the thin atrial wall. 24 Cavo-pulmonary assist devices where blood is "sucked" across the pulmonary vascular bed have also been described, 29 with or without a systemic VAD.…”

Section: Vads For Neonates and Infants In The Pre-glenn Stagementioning

confidence: 99%

Pediatric ventricular assist devices: Bridge to a new era of perioperative care

Navaratnam

Maeda

Hollander

2019

Pediatric Anesthesia

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Summary Pediatric ventricular assist devices (VADs) are evolving as a standard therapy for end stage heart failure in children. Major recent developments include the increased use of continuous flow (CF) devices in children and increased experience with congenital heart disease (CHD) and outpatient management. In the current and future era anesthesiologists will encounter more children presenting for VAD implantation, subsequent procedures and heart transplantation. Successful perioperative management requires an understanding of the interaction between the patient's physiology and the device and a framework to troubleshoot problems. This review focuses on CF devices, VAD support for CHD and perioperative management of pulsatile and CF devices in the pediatric population.

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“…[58][59][60][61][62][63][64][65][66][67][68][69] At our institution, we used a VAD to facilitate Fontan completion in a patient with Glenn physiology and severe ventricular dysfunction. 70 A recent article demonstrated the promise of temporary, catheter-based VAD support of the failing systemic ventricle. 71 Several patients with failing Fontan physiology have received simultaneous support of both the pulmonary and systemic arterial circulations (or pseudo ''biventricular support'') with device therapy including with dual Berlin EX-COR devices (Berlin Heart, Berlin, Germany) or the SynCardia total artificial heart (SynCardia Systems, LLC, Tucson, Ariz).…”

Section: Clinical Fontan Circulation Assistancementioning

confidence: 99%

Progress in experimental and clinical subpulmonary assistance for Fontan circulation

Broda¹,

Taylor²,

Adachi

2018

The Journal of Thoracic and Cardiovascular Surgery

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Experimental subpulmonary assist device for Fontan circulation: von Karman impeller pump. Central Message Patients with Fontan circulation experience sequelae related to chronic attrition from altered hemodynamics; a subpulmonary assist device may improve cardiovascular status and alleviate symptoms. Perspective Investigators have formulated creative solutions to address the unmet need for subpulmonary Fontan circulation assistance, but substantial clinical translation has not been realized. In this article, we review experimental and clinical attempts for cavopulmonary assistance in patients with single ventricles and highlight promising strategies to create a subpulmonary assist device for the Fontan circulation.

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Mechanically assisted Fontan completion: A new approach for the failing Glenn circulation due to isolated ventricular dysfunction

Cited by 32 publications

References 5 publications

Outcomes of children with congenital heart disease implanted with ventricular assist devices: An analysis of the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs)

Outcomes of children with congenital heart disease implanted with ventricular assist devices: An analysis of the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs)

Pediatric ventricular assist devices: Bridge to a new era of perioperative care

Progress in experimental and clinical subpulmonary assistance for Fontan circulation

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