Background
Ventricular assist device (VAD) support for failing Glenn circulation represents a
unique challenge.
Methods
We conducted a retrospective review of clinical outcomes in patients with VAD support
for failing Glenn circulation between 2010 and 2020 at a tertiary pediatric institution.
Results
Ten patients were included: INTERMACS profiles were 1 in 3 patients and 2 in 7 patients.
The median age, weight, and body surface area were 3.2 years, 13.0 kg, and 0.5 m2, respectively. Seven patients (70%) were implanted with continuous-flow devices and
3 with para-corporeal devices. Nine patients (90%) received heart transplant, with
a median support duration of 77 days. Four (67%) out of 6 patients supported with
discharge-capable devices were managed as outpatients. Post-transplant survival was
100%, with a median (range) follow up duration of 3.5 (1.8-11.9) years. There were
3 neurologic complications in 3 patients (0.9 events per patient-year); 2 intraoperative
events (fatal hypoxia and symptomatic embolic stroke) and 1 postoperative (asymptomatic
subarachnoid hemorrhage). Pump thrombosis occurred in one patient (0.3 events per
patient-year), requiring pump exchange at day 65. Five patients (50%) received concomitant
Fontan completion (fenestrated in 1). The Fontan-upgraded patients (vs Glenn) tended
to be larger (median (range): 15.9 (12.6-22.9) vs 9.1 (7.7-22.8) kg), older (4.7 (3.1-6.5)
vs 1.1 (0.9-10.1) years) and had a higher PaO2/FiO2 ratio (192 (52-336) vs 76 (59-78) mm Hg) on postoperative day 1.
Conclusion
Our experience suggests the feasibility of durable VAD support for failing Glenn circulation.
Concomitant Fontan completion may be considered in select patients to improve oxygen
delivery.
KEYWORDS
Abbreviation:
INTERMACS (Interagency registry for mechanically assisted circulatory support), PEDIMACS (Pediatric interagency registry for mechanical circulatory support), RV (Right ventricle, VAD: Ventricular assist device)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 12, 2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 International Society for Heart and Lung Transplantation. All rights reserved.
