title: Durable ventricular assist device support for failing systemic morphologic right ventricle: early results.
abstract: BACKGROUND
  The systemic morphologic right ventricle (RV) in congenitally corrected transposition of the great arteries or after atrial switch for transposition of the great arteries is associated with late ventricular failure. Although the role of the left ventricular assist device (LVAD) in supporting the failing LV is established, the indications and outcomes of using LVAD in a systemic RV remain unclear. We assessed the role of a third-generation LVAD for systemic RV support.
  
  
  METHODS
  Seven patients (mean age, 36 years) received the HeartWare (HeartWare International Inc, Framingham, MA) VAD for systemic RV failure (congenitally corrected transposition of the great arteries in 1 and after atrial switch in 6). Four patients (57%) had severe subpulmonic LV failure, and aggressive perioperative diuresis with or without hemofiltration was used to offload the subpulmonic LV. The indications of VAD were (1) bridge to transplant in 3 and (2) bridge to decision for a high transpulmonary gradient in 4. Transplantation outcome was compared with systemic RV failure without VAD bridge in 19 patients (years 1989 to 2013).
  
  
  RESULTS
  Systemic RV support alone was achieved in all patients, with no early deaths (≤30 days). Overall, 6 (86%) returned home, 3 (44%) received a transplant, 2 (28%) died of noncardiac causes, and 2 (28%) continue on VAD support (median support, 232 days). Repeat catheterization (n = 4) showed an improved median transpulmonary gradient in 3 patients (median 18.5 mm Hg pre-VAD vs 8.0 mm Hg post-VAD). Two bridge-to-decision patients received transplants at 640 and 685 days. The stroke rate on VAD support was 43% (2 thromboembolic and 1 hemorrhagic; 3 with satisfactory recovery). De novo aortic regurgitation was 29% (n = 2; 1 valve replacement). All patients (n = 3) survived transplantation (vs 10.5% early mortality without VAD bridge; p = 1.00) and were well at follow-up (range, 53 to 700 days).
  
  
  CONCLUSIONS
  The third-generation VAD provides durable support for systemic RV failure as a bridge to transplant and as a strategy to reduce pulmonary vascular resistance. Although concomitant subpulmonic LV failure is common, systemic RV support alone was achieved in all patients.
authors.affiliation: Children's Heart Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom; Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Ed
authors.initials: E
authors.lastname: Peng
authors.affiliation: Children's Heart Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: John J
authors.initials: JJ
authors.lastname: O'Sullivan
authors.affiliation: Children's Heart Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom; Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Massimo
authors.initials: M
authors.lastname: Griselli
authors.affiliation: Cardiothoracic Anaesthesia, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Chandrika
authors.initials: C
authors.lastname: Roysam
authors.affiliation: Children's Heart Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Crossland
authors.affiliation: Children's Heart Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Milind
authors.initials: M
authors.lastname: Chaudhari
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Wrightson
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Butt
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Gareth
authors.initials: G
authors.lastname: Parry
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Guy A
authors.initials: GA
authors.lastname: MacGowan
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Stephan
authors.initials: S
authors.lastname: Schueler
authors.affiliation: Children's Heart Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom; Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom. Electronic address: asif.hasan@nuth.nhs.uk.
authors.forename: Asif
authors.initials: A
authors.lastname: Hasan
mesh_terms: D000328:Adult; D004389:Durable Medical Equipment; D004452:Echocardiography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000150:complications*; D016896:Treatment Outcome; D014655:Vascular Resistance; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016278:Ventricular Function, Right / Q000502:physiology*