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Ventricular assist device implantation in a patient with systemic right ventricle and pectus excavatum.

ABSTRACT: Systemic right ventricular failure is a common finding in patients with transposition of the great arteries. Some of these patients require ventricular assist device implantation. We describe the feasibility of HeartMate 3 [Abbott, Illinois, United States] implantation in a patient with transposition of the great arteries, high human leukocyte antigen sensitization, and severe pectus excavatum using a two-stage approach.

Learning objectives

1.To notice the challenges faced while implanting HeartMate 3 [Abbott, Illinois, United States] in patients with congenital heart disease and anatomical limitations.2.To understand that despite the difficulties, HeartMate 3 implantation is possible, worthwhile, and sometimes the only choice in a patient with end-stage heart failure and congenital heart disease.

SUBMITTER: Ansari Ramandi MM

PROVIDER: S-EPMC9352421 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Ventricular assist device implantation in a patient with systemic right ventricle and pectus excavatum.

Ansari Ramandi Mohammad Mostafa MM van den Broek Stan A J SAJ Mecozzi Gianclaudio G Erasmus Michiel E ME van Melle Joost P JP Damman Kevin K

Journal of cardiology cases 20220502 2

Systemic right ventricular failure is a common finding in patients with transposition of the great arteries. Some of these patients require ventricular assist device implantation. We describe the feasibility of HeartMate 3 [Abbott, Illinois, United States] implantation in a patient with transposition of the great arteries, high human leukocyte antigen sensitization, and severe pectus excavatum using a two-stage approach.<h4>Learning objectives</h4>1.To notice the challenges faced while implantin ...[more]

PMID: 35949576

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Durable ventricular assist device implantation for systemic right ventricle: a case series.

Project description:BackgroundA systemic right ventricle (RV) after atrial switch in transposition of the great arteries (TGA) or congenitally corrected TGA (ccTGA) often results in advanced heart failure in adulthood.Case summaryFour patients with INTERMACS Class III underwent durable ventricular assist device (VAD) implantation for a systemic RV. Two patients were diagnosed with ccTGA and underwent tricuspid valve replacement, and two were diagnosed with TGA in childhood and underwent Mustard repair. The two patients with ccTGA received an EVAHEART (Sun Medical, Nagano, Japan) and HeartMate 3 (Abbott Laboratories, Abbott Park, IL, USA) at the age of 56 years and 34 years, respectively. Of the patients with TGA, one received a Heartmate II at age 40 years, and one received a HeartMate 3 at age 40 years. All patients were weaned from cardiopulmonary bypass without subpulmonic VAD support and transferred to the intensive care unit with optimum VAD support. No in-hospital deaths, cerebrovascular accidents, or other major complications occurred. The post-VAD right heart catheter study showed a remarkable reduction in pulmonary capillary wedge pressure in all patients.DiscussionThe indications for and surgical technique of durable VAD implantation for a systemic RV after atrial switch of TGA or ccTGA have not been fully established. A durable VAD, including the HeartMate 3, was successfully implanted in four such patients in this study. Pre-operative three-dimensional computed tomography images and intraoperative transoesophageal echocardiography guidance helped to determine the positions of the inflow and pump.

| S-EPMC7891278 | biostudies-literature

Hybrid closure of ventricular septal defect and implantation of systemic right ventricular assist device.

Project description:A 50-year-old female patient was readmitted with refractory systemic right ventricular failure. The patient underwent a Mustard procedure during childhood for transposition of the great arteries. A significant residual ventricular septal defect was present, which represents a major risk factor of death following ventricular assist device. We describe the combination of ventricular assist device implantation preceded by hybrid closure of ventricular septal defect.

| S-EPMC9715863 | biostudies-literature

Ventricular assist device implantation in adults with a systemic right ventricle - A single center experience and review of the literature.

Project description:Patients with a systemic right ventricle (sRV) have a high risk of developing heart failure (HF), with heart transplantation as the only long-term treatment option. Unfortunately, more than half of sRV patients have pulmonary hypertension (PH) which may impact the decision to opt for heart-only transplantation. Moreover, an increased scarcity of donor hearts prolongs time to transplantation, increasing the probability of dying on the waiting list. Hence, for selected sRV patients, a ventricular assist device (VAD) could provide a solution to bridge the time to transplantation. This case series aimed at evaluating all patients with a sRV who received a VAD at our institution, with a focus on technical aspects of VAD implantation and invasive hemodynamics prior to VAD implantation and after heart transplantation. In total 5 patients with a sRV who received a VAD at our institution were included. All five were male with a median age of 38 years (19-49) at the time of VAD implantation. All patients were subsequently successfully transplanted. Pulmonary artery (PA) pressures were significantly elevated prior to VAD implantation and decreased significantly after VAD implantation and subsequent heart transplantation. With this case series we highlight the ability of a VAD to support the failing sRV, as well as to reduce PA pressures, making patients eligible for heart-only transplantation.

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Outcome of right ventricular assist device implantation following left ventricular assist device implantation: Systematic review and meta-analysis.

Project description:ObjectivesThe main aim was a systematic evaluation of the current evidence on outcomes for patients undergoing right ventricular assist device (RVAD) implantation following left ventricular assist device (LVAD) implantation.MethodsThis systematic review was registered on PROSPERO (CRD42019130131). Reports evaluating in-hospital as well as follow-up outcome in LVAD and LVAD/RVAD implantation were identified through Ovid Medline, Web of Science and EMBASE. The primary endpoint was mortality at the hospital stay and at follow-up. Pooled incidence of defined endpoints was calculated by using random effects models.ResultsA total of 35 retrospective studies that included 3260 patients were analyzed. 30 days mortality was in favour of isolated LVAD implantation 6.74% (1.98-11.5%) versus 31.9% (19.78-44.02%) p = 0.001 in LVAD with temporary need for RVAD. During the hospital stay the incidence of major bleeding was 18.7% (18.2-19.4%) versus 40.0% (36.3-48.8%) and stroke rate was 5.6% (5.4-5.8%) versus 20.9% (16.8-28.3%) and was in favour of isolated LVAD implantation. Mortality reported at short-term as well at long-term was 19.66% (CI 15.73-23.59%) and 33.90% (CI 8.84-59.96%) in LVAD respectively versus 45.35% (CI 35.31-55.4%) p ⩽ 0.001 and 48.23% (CI 16.01-80.45%) p = 0.686 in LVAD/RVAD group respectively.ConclusionImplantation of a temporary RVAD is allied with a worse outcome during the primary hospitalization and at follow-up. Compared to isolated LVAD support, biventricular mechanical circulatory support leads to an elevated mortality and higher incidence of adverse events such as bleeding and stroke.

| S-EPMC9619248 | biostudies-literature

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Project description: Not available

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Project description: Not available

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Preoperative risk factors of early right ventricular failure-following left ventricular assist device implantation.

Project description: Not available

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Right ventricular failure after left ventricular assist device implantation: a review of the literature.

Project description:Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation remains a major complication which may significantly impair patient outcome. The genesis of RVF is, however, multifactorial, and the mechanisms underlying such a condition have not been fully elucidated, making its prevention challenging and the course not always predictable. Although preoperative risks factors can be associated with RV impairment, the physiologic changes after the LV support, can still hamper the function of the RV. Current medical treatment options are limited and sometimes, patients with a severe post-LVAD RVF may be unresponsive to pharmacological therapy and require more aggressive treatment, such as temporary RV support. We retrieved 11 publications which we assessed and divided in groups based on the RV support [extracorporeal membrane oxygenation (ECMO), right ventricular assist device (RVAD), TandemHeart with ProtekDuo cannula]. The current review comprehensively summarizes the main studies of the literature with particular attention to the RV physiology and its changes after the LVAD implantation, the predictors and prognostic score as well as the different modalities of temporary mechanical cardio-circulatory support, and its effects on patient prognosis for RVF in such a setting. In addition, it provides a decision making of the pre-, intra and post-operative management in high- and moderate- risk patients.

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