Original articleAdult cardiacDurable Ventricular Assist Device Support for Failing Systemic Morphologic Right Ventricle: Early Results
Section snippets
Patients and Methods
From October 2010 to April 2014, 7 patients (6 men; mean age, 36 years [range, 26 to 41 years]; 6 post-atrial switch, 1 ccTGA; 6 redo operations) received the HeartWare HVAD (HeartWare International Inc, Framingham, MA), a third-generation LVAD, to support systemic RV failure (Table 1). Preoperative echocardiography confirmed severe systemic RV failure in all patients. Concomitant subpulmonic morphologic LV failure was also present in 6 (86%); impairment was mild to moderate in 1, moderate in
Results
Overall, 6 patients (86%) were discharged home, 3 (44%) received a transplant, and 2 (28%) died of a noncardiac cause (Fig 3). The most recent 2 patients (28%) are currently still on VAD support and are waiting for a transplant from home (median support, 232 days; range, 30 to 685 days). VAD support for the systemic ventricle alone was achieved in all patients, with no early deaths (≤30 days).
Comment
Our report shows that the third-generation continuous-flow LVAD technology can be used to provide durable support for systemic RV failure as a BTT and as a strategy to reduce PVR. The BTT patients were sicker on inotrope therapy in INTERMACS class II compared with BTD patients who were not on inotrope therapy in INTERMACS class IV. Although this is the largest series of systemic RV failure patients supported on VAD in the literature, this represents an early and evolving experience of a limited
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