The Total Artificial Heart in End-Stage Congenital Heart Disease

Villa, Chet; Morales, David L.S.

doi:10.3389/fphys.2017.00131

Cited by 20 publications

(7 citation statements)

References 68 publications

(91 reference statements)

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“…As expected, CHD patients were more frequently found in the No MCS group. The hesitancy to use MCS in CHD patients is likely due to a combination of factors such as size, complex anatomy, and more hepatic, renal, and pulmonary end‐organ dysfunction resulting from systolic and diastolic dysfunction 17‐22 . However, more CHD patients are now benefiting from MCS as the number of heart failure admissions in CHD patients continues to grow 23,24 .…”

Section: Discussionmentioning

confidence: 99%

“…The hesitancy to use MCS in CHD patients is likely due to a combination of factors such as size, complex anatomy, and more hepatic, renal, and pulmonary end-organ dysfunction resulting from systolic and diastolic dysfunction. [17][18][19][20][21][22] However, more CHD patients are now benefiting from MCS as the number of heart failure admissions in CHD patients continues to grow. 23,24 Additionally, even though they are generally more ill, the post-transplant survival of CHD patients BTT on VAD support is similar to CHD patients not BTT.…”

Section: Discussionmentioning

confidence: 99%

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Impact of mechanical circulatory support on pediatric heart transplant candidates with elevated pulmonary vascular resistance

Thangappan

Morales

et al. 2020

Artificial Organs

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With the new era of increasing use of mechanical circulatory support (MCS) in children, seemingly more patients with elevated pulmonary vascular resistance (PVR) are having positive outcomes. The purpose of this study was to define the effect of MCS on pediatric patients listed for heart transplant with an elevated PVR. The United Network for Organ Sharing (UNOS) database was used to identify patients aged 0‐18 at the time of listing for heart transplant between 2010 and 2019 who had PVR documented (n = 2081). Patients were divided into MCS (LVAD, RVAD, BiVAD, and TAH) and No MCS groups, then divided by PVR (PVR) at the time of listing: <3, 3‐6, and >6 Wood units (WU). MCS was used in 20% overall (n = 426); 57% of those with PVR <3, 27% with PVR 3‐6, and 16% with PVR >6. MCS, PVR <3 patients had a higher chance of positive waitlist outcome than all No MCS groups (vs. PVR <3, P = .049; vs. PVR 3‐6, P = .004; vs. PVR >6, P < .001). MCS, PVR 3‐6 patients had a higher chance of positive waitlist outcome than all No MCS groups (vs. PVR <3, P = .048; vs. PVR 3‐6, P = .009; vs. PVR >6, P < .001). MCS, PVR >6 patients had a higher chance of positive waitlist outcome than No MCS, PVR >6 patients (P = .012). Within the No MCS group, patients with a PVR >6 had a higher incidence of negative waitlist outcome compared to PVR <3 (17% vs. 10%, P = .002); this was not the case in the MCS group (5% vs. 6%, P = .693). More patients in the MCS group were ventilator dependent (15% vs. 9%, P < .001) at the time of listing and less likely to have a functional status >50% (43% vs. 73%, P < .001). No significant differences in post‐transplant survival were found in pairwise comparisons of MCS and No MCS PVR subgroups. Patients supported with MCS had a significantly higher chance of a positive waitlist outcome than those without such support regardless of PVR status. This was most pronounced with a PVR greater than 6 WU. MCS compared to No MCS patients had better waitlist survival and equivalent post‐transplant survival. MCS patients, despite being more ill, had better overall survival regardless of PVR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of mechanical circulatory support on pediatric heart transplant candidates with elevated pulmonary vascular resistance

Thangappan

Morales

et al. 2020

Artificial Organs

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“…SynCardia CardioWest TAH (SynCardia) is the world’s first and only commercially approved total artificial heart that is currently in use today [72]. The mechanics of the device are fairly simple.…”

Section: Current State Of the Artmentioning

confidence: 99%

Cardiac Assist Devices: Early Concepts, Current Technologies, and Future Innovations

Han

Trumble

2019

Bioengineering

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Congestive heart failure (CHF) is a debilitating condition that afflicts tens of millions of people worldwide and is responsible for more deaths each year than all cancers combined. Because donor hearts for transplantation are in short supply, a safe and durable means of mechanical circulatory support could extend the lives and reduce the suffering of millions. But while the profusion of blood pumps available to clinicians in 2019 tend to work extremely well in the short term (hours to weeks/months), every long-term cardiac assist device on the market today is limited by the same two problems: infections caused by percutaneous drivelines and thrombotic events associated with the use of blood-contacting surfaces. A fundamental change in device design is needed to address both these problems and ultimately make a device that can support the heart indefinitely. Toward that end, several groups are currently developing devices without blood-contacting surfaces and/or extracorporeal power sources with the aim of providing a safe, tether-free means to support the failing heart over extended periods of time.

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“…Although reports exist of these patients being bridged with ECMO to VAD and ultimate transplantation, use of ECMO in this subgroup caries an even higher risk of mortality ( 19 ). The majority of the focus of the mid and late phase Fontan failure patients has shifted toward VAD and other forms of mechanical support such as the total artificial heart ( 19 , 23 , 24 ). This is beyond the scope of this review; however, a high percentage of Fontan failure patients were bridged to VAD with ECMO support indicating that it is possible to support these patients if even for a short time.…”

Section: Ecmo In Patients Following the Fontan Proceduresmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation (ECMO) Support in Special Patient Populations—The Bidirectional Glenn and Fontan Circulations

2018

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Extracorporeal membrane oxygenation (ECMO) is a support modality used within the pediatric cardiac ICU population as a bridge to recovery or decision in the setting of acute myocardial decompensation, support for combined cardiopulmonary failure or in the setting of refractory cardiopulmonary arrest. Patients with univentricular physiology are at particular risk for decompensation requiring ECMO support. This review will focus upon current evidence and techniques for ECMO support of single ventricle patients who have undergone a stage II bidirectional Glenn procedure or the stage III Fontan procedure.

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The Total Artificial Heart in End-Stage Congenital Heart Disease

Cited by 20 publications

References 68 publications

Impact of mechanical circulatory support on pediatric heart transplant candidates with elevated pulmonary vascular resistance

Impact of mechanical circulatory support on pediatric heart transplant candidates with elevated pulmonary vascular resistance

Cardiac Assist Devices: Early Concepts, Current Technologies, and Future Innovations

Extracorporeal Membrane Oxygenation (ECMO) Support in Special Patient Populations—The Bidirectional Glenn and Fontan Circulations

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