title: Clinical outcomes after ventricular assist device implantation in adults with complex congenital heart disease.
abstract: BACKGROUND
  There are minimal data regarding ventricular assist device (VAD) implantation in adult patients with complex congenital heart disease (CHD).
  
  
  METHODS
  The medical records of 6 adult patients with complex CHD who underwent VAD implantation were retrospectively analyzed to characterize pre-operative clinical status, implantation techniques and challenges, post-operative management, and post-operative outcomes.
  
  
  RESULTS
  All patients had a systemic right ventricle, including 2 with single-ventricle physiology. The average age at VAD implantation was 41 years. The implanted VADs included 1 HeartMate XVE, 3 HeartMate II (Thoratec Corp, Pleasanton, CA), 1 Jarvik 2000 (Jarvik Heart, New York, NY), and 1 HeartWare HVAD (HeartWare Inc, Framingham, MA). In-hospital outcomes included no sub-pulmonic ventricular failure, no VAD thrombosis or mechanical failure, 30-day mortality in 1 patient, non-fatal sub-arachnoid hemorrhage in 1 patient, and sustained ventricular tachycardia requiring unsynchronized direct current cardioversion in 1 patient. Of the 5 patients who survived to discharge, 1 patient received 171 days of VAD support before cardiac transplantation and survived for 1,484 days after transplantation; 1 patient received 262 days of VAD support before out-of-hospital death of unknown etiology; 1 patient had received VAD support for 988 days as of December 1, 2012, while awaiting a transplant; and 2 patients who received VADs as destination therapy had received 577 and 493 days of VAD support, respectively, and were still alive as of December 1, 2012.
  
  
  CONCLUSIONS
  This case series characterizes important post-operative management challenges and clinical outcomes associated with VAD implantation as a bridge-to-transplant or as destination therapy in adult patients with complex CHD.
authors.affiliation: Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA.
authors.forename: Nishant R
authors.initials: NR
authors.lastname: Shah
authors.forename: Wilson W
authors.initials: WW
authors.lastname: Lam
authors.forename: Fred H
authors.initials: FH
authors.lastname: Rodriguez
authors.forename: Peter R
authors.initials: PR
authors.lastname: Ermis
authors.forename: Leo
authors.initials: L
authors.lastname: Simpson
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Franklin
authors.forename: Dhaval R
authors.initials: DR
authors.lastname: Parekh
mesh_terms: D000328:Adult; D019468:Disease Management; D005260:Female; D006331:Heart Diseases / Q000151:congenital* / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices / Q000145:classification; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome