Single Ventricular Assist Device Support for the Failing Bidirectional Glenn Patient

Mechanical support of superior cavopulmonary (Glenn) physiology to heart transplantation

“…These have significant downsides as the shunted physiology is an unstable one while too-early conversion can result in elevated Fontan circuit pressures and low cardiac output. 2,5 In an early Glenn failure like we have presented, then, support with temporary VA-ECMO in addition to the durable VAD can be valuable. Particularly through the initial postoperative period when the physiology is most tenuous, and the pulmonary vascular bed perhaps most reactive, this dual support can facilitate successful long-term support of the Glenn physiology.…”

“…1 However, the appetite for assist of the second-stage bidirectional cavopulmonary connection continues to lag because it is fraught with challenges, including respiratory failure, leading to inferior outcomes. 2 We report the successful bridge to transplantation of a child with failing superior cavopulmonary circulation using the EX-COR pediatric ventricular assist device (VAD), Berlin VAD (Berlin Heart, Berlin, Germany), and interval parallel venoarterial (VA) extracorporeal membrane oxygenation (ECMO) (Video 1).…”

A Review of Physiologic Considerations and Challenges in Pediatric Patients With Failing Single- Ventricle Physiology Undergoing Ventricular Assist Device Placement

“…Additionally, cannulation strategies implementing atrial inflow cannulation over ventricular inflow cannulation may provide superior support in BDG patients requiring SVAD therapy. In a report comparing both strategies following device implantation in patients with failing SCPC, VAD flows tended to be higher (median 5.2 L/m 2 vs 2.4 L/m 2 ) and filling pressures tended to be lower (median 6 mmHg vs 11 mmHg) in the atrial cannulation group 31 .…”

“…Additionally, the SCPC does not entirely correct cyanosis as deoxygenated blood from the IVC still enters the systemic circulation. This results in an inability to increase oxygenation with increased device flows as desaturated blood entering the atrium from the IVC is directed into the VAD 31 . As this issue remains unique to this stage of palliation, the performance of concomitant Fontan completion at the time of VAD placement would effectively eliminate these unwanted sequelae (i.e., mechanically assisted Fontan completion) 32 .…”

Commentary: Mechanical circulatory support for the failing Glenn circulation: Keep all options on the table and don't give up

“…Fontan completion. 2,3 The patient's specific mode of cardiopulmonary failure and anatomic complexities of the patient, as well as the strengths of the individual heart failure program factor into the decision matrix on how to proceed. In the present case, the mode of failure appeared to be related primarily to ventricular dysfunction, and the Glenn/pulmonary circuit proved adequate for long-term oxygenation of the patient.…”