Mechanical circulatory support in patients with heart failure secondary to transposition of the great arteries. J Heart Lung Transplant 2010 Nov;29(11):1302-5
Date
07/14/2010Pubmed ID
20620085DOI
10.1016/j.healun.2010.05.030Scopus ID
2-s2.0-78049318869 (requires institutional sign-in at Scopus site) 73 CitationsAbstract
Advances in palliation of congenital heart disease have resulted in improved survival to adulthood. Many of these patients ultimately develop end-stage heart failure requiring left ventricular assist device implantation (LVAD). However, morphologic differences in the systemic ventricle of these patients require careful attention to cannula placement. We report on the evolution of our surgical technique for implanting LVADs in 3 patients with transposition of the great arteries and congenitally corrected transposition of the great arteries. Applying standard LV cannulation techniques to the systemic ventricle led us too anteriorly in our first patient, creating obstruction by the moderator band. Subsequent use of epicardial and transesophageal echocardiography allowed for intraoperative localization of the intracardiac muscular structures to identify the optimal cannulation site. The acute angle of the inflow cannula on the DeBakey LVAD (MicroMed Technology, Houston, TX) required flipping the device 180°. The HeartMate II device (Thoratec, Pleasanton, CA) could be shifted towards the midline. One patient underwent successful transplant and 2 are home waiting for a donor organ. We conclude from our experience that LVAD surgery can be safely performed in patients with congenital heart disease when implanted under echocardiographic guidance.
Author List
Joyce DL, Crow SS, John R, St Louis JD, Braunlin EA, Pyles LA, Kofflin P, Joyce LDMESH terms used to index this publication - Major topics in bold
AdultCardiovascular Surgical Procedures
Echocardiography, Transesophageal
Female
Heart Failure
Heart-Assist Devices
Humans
Male
Radiography, Thoracic
Transposition of Great Vessels
Treatment Outcome
