Ventricular assist device implantation in patients with a failing systemic right ventricle: a call to expand current practice

Abstract

Ventricular assist device (VAD) implantation is an established treatment modality for patients with end-stage heart failure, and improves symptoms and survival. In the Netherlands, it is not yet routinely considered in patients with congenital heart disease and failing systemic right ventricle (SRV). Recently, a VAD was implanted in 2 SRV patients, one who underwent a Mustard procedure during infancy for transposition of the great arteries (male, 47 years old) and one with a congenitally corrected transposition of the great arteries (male, 54 years old). The first patient is doing well >1 year after implantation; the second patient will be discharged home soon. These examples and other reports demonstrate the feasibility of adopting VAD implantation into routine care for SRV failure. In conclusion, patients with SRV failure may be suitable candidates for VAD implantation: they are relatively young, usually have a preserved subpulmonary left ventricular function, and their specific anatomical and physiological characteristics often make them unsuitable for cardiac transplantation. Therefore it is important to recognise the possibility of VAD implantation early in the process of SRV failure, and to timely refer these patients to a heart failure clinic with experience in VAD implantation in this group of patients for optimisation, screening, and implantation.

Sacubitril/valsartan in the treatment of systemic right ventricular failure

“…When confronted with advanced heart failure, VAD implantation as destination therapy shows promising results in patient with systemic RV failure. 30 The present study demonstrates that sacubitril/valsartan results in improved RV function, exercise capacity and QOL in symptomatic patients with systemic RV.…”

The first experience with sodium‐glucose cotransporter 2 inhibitor for the treatment of systemic right ventricular failure

“…17 Looking beyond pharmacological options for advanced sRV failure, we enter the domain of heart transplantation and ventricular assist device (VAD) therapy. 18,19 Although our patient is young without extracardiac comorbidities and is currently being screened for cardiac transplantation eligibility, donor hearts remain scarce and Dutch data report a high waiting list mortality (15% before a suitable donor becomes available) with a median waiting time of 2.6 years and only 50% of the eligible patients being transplanted in the period 2013-17. 20 Only about 40 heart transplantations have been performed in the Netherlands annually and this number has not significantly increased over the recent years.…”

“…20 Timely referral for transplantation and awareness of alternatives such as VAD is important. 18 However, prevention is better than cure and efforts to halt progression of sRV failure are pivotal. Inherent to the nature of this report, one should recognize that the observed functional improvement and reduced heart-failure-related hospitalization burden reported may have been merely incidental and not related to the initiation of treatment with dapagliflozin.…”

Failing systemic right ventricle in a patient with dextrocardia and complex congenitally corrected transposition of the great arteries: a case report of successful transvenous cardiac resynchronization therapy

“…Despite the potential complications of a VAD, it has been shown to be feasible in sRV patients and to result in survival benefit and clinical improvement. 12 …”