Paediatric Ventricular Assist Device for Mechanical Circulatory Support: 10-year Experience of a Single Centre

Abstract

Aim: To investigate parental decisions associated with the antenatal diagnosis of hypoplasia of the left ventricle spectrum (HLV), and intermediate-term outcome. Methods: A cohort study was performed on all families with a foetal diagnosis of HLV. Assessment was performed at the sole tertiary cardiac feto-maternal service for Queensland from 2008 to 2012. Demographic data, incidence of termination of pregnancy, and post-natal survival outcomes were recorded. Results: HLV was diagnosed (using standardised foetal echocardiographic criteria) in 81 pregnancies. Sixty-two (76.5%) had HLHS (aortic ± mitral atresia), with the remainder having HLV variants. Three (3.7%) foetuses had chromosomal abnormalities. Median gestation at initial tertiary assessment was 21 weeks (range 16-36 weeks). Thirty-eight (46.9%) families were not from metropolitan Brisbane. Forty-five (55.8%) families elected termination of pregnancy. Seventeen (21%) families elected palliative care following delivery. Nineteen (23.5%) infants diagnosed antenatally were referred for surgery, and 14 (73.7%) were referred to RCH, Melbourne. There was no significant variation in antenatal and postnatal diagnosis. Sixteen (84.2%) had Norwood operations, two (10.5%) had bi-ventricular repairs and one (5.3%) is awaiting delivery. Fourteen (77.7%) surgically treated infants are alive at a median follow-up of 21 months (range 1-57 months). One patient has undergone a Fontan operation. Overall this represents an 82.7% intermediate loss (elective termination, palliative care and operative mortality) for foetuses following antenatal diagnosis of HLV. Conclusion: In our unit, foetal diagnosis of HLV is associated with a high probability of death, noting that the majority of mortality was in non-surgical cases.