Ventricular assist device support in patients with single ventricles: the Melbourne experience
| Autor: | Yves d'Udekem, Igor E. Konstantinov, Diana Zannino, Johnny Millar, Roberto Chiletti, Stephen Horton, Chin L. Poh, Christian P. Brizard |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Pulmonary and Respiratory Medicine
Heart Defects Congenital Male medicine.medical_specialty Palliative care Victoria medicine.medical_treatment Heart Ventricles Population 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Interquartile range Internal medicine medicine Extracorporeal membrane oxygenation Humans cardiovascular diseases Hospital Mortality education Retrospective Studies Heart transplantation education.field_of_study business.industry Infant Newborn Infant Transplantation Survival Rate Treatment Outcome 030228 respiratory system Ventricular assist device Life support Cardiology Feasibility Studies Surgery Female Heart-Assist Devices Cardiology and Cardiovascular Medicine business |
| Zdroj: | Interactive cardiovascular and thoracic surgery. 25(2) |
| ISSN: | 1569-9285 |
| Popis: | OBJECTIVES: The capacity and limitations of ventricular assist device (VAD) support in single-ventricle physiology remains poorly understood. We aimed to review our experience in the use of VAD support in the single-ventricle circulation to determine its feasibility in this population. METHODS: We reviewed our experience with VAD support in patients with single ventricles over the past 25 years. Fifty-seven patients received 64 runs of VAD support between 1990 and 2015 at a median age of 13 days [interquartile range (IQR) 4.1-99.4 days], of which 55 were supported for post-cardiotomy failure. The majority of patients received short-term VAD support, while 4 patients were either directly supported (1) or transitioned onto the Berlin Heart EXCOR (3). RESULTS: The median duration of support was 3.5 days (IQR 2.8-5.2 days). Twelve patients suffered significant neurological complications, and thromboembolic events occurred in 8 patients. Twenty-nine of the 55 patients were successfully weaned off support (53%). There were 37 inpatient deaths, with a survival-to-hospital discharge rate of 33% (18 of 55). Of the 4 patients supported after early Fontan failure, 3 died. Having a higher mean arterial blood pressure on initiation of VAD support was the only significant predictor of death (hazards ratio 1.08; 95% confidence interval 1.03-1.14; P = 0.002). Patients who required a second run of support had higher hospital mortality (83% vs 63%; P = 0.84). Of the hospital survivors, 12 patients (63%) remain alive without heart transplantation at median 7.2 years (IQR 3.5-14.0) post VAD support. CONCLUSIONS: VAD support in patients with a single ventricle has a high hospital mortality, with 1 of 3 patients surviving to discharge. Systemic VAD support is likely futile in the setting of early Fontan failure or when re-initiation of support is required. |
| Databáze: | OpenAIRE |
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