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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Ventricular assist device support for failing Glenn circulation: Impact of concomitant Fontan completion in select patients

Published:December 12, 2022DOI:https://doi.org/10.1016/j.healun.2022.12.003

      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)
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