title: Bridge to transplantation with long-term mechanical assist device in adults after the Mustard procedure.
abstract: BACKGROUND
  There is limited clinical experience with bridging to transplant with a left ventricular assist device (VAD) in patients with previously palliated transposition of great arteries.
  
  
  METHODS
  Five adult patients presenting with systemic right ventricular failure 30 years after a Mustard operation were implanted with a HeartMate II VAD. The implant was completed using standard procedures with only minor modifications to accommodate right ventricular cannulation.
  
  
  RESULTS
  All 5 patients were men, with a mean age of 31.5 ± 1.8 years and a median time since Mustard operation of 30 (range 28 to 32) years. All patients had sternal closure on Post-operative Day (POD) 1, and 2 patients required additional re-operation for bleeding. One patient required temporary support of the non-systemic ventricle. The mean duration of VAD support was 284 ± 177 days; 3 patients underwent heart transplant and 2 died on PODs 502 and 34, respectively. Both deaths were due to progressive heart failure and pump thrombosis. Comorbidities, anatomy and mediastinal scarring did not preclude implantation and heart failure symptoms improved in all patients.
  
  
  CONCLUSIONS
  With the increased prevalence of late post-Mustard heart failure, bridge to transplant with a VAD may be a suitable treatment option for patients who are severely ill.
authors.affiliation: Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Maly
authors.affiliation: Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Ivan
authors.initials: I
authors.lastname: Netuka
authors.affiliation: Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Besik
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Zora
authors.initials: Z
authors.lastname: Dorazilova
authors.affiliation: Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Pirk
authors.affiliation: Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. Electronic address: onsz@ikem.cz.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Szarszoi
mesh_terms: D000328:Adult; D000069278:Arterial Switch Operation; D016027:Heart Transplantation / Q000401:mortality; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D014188:Transposition of Great Vessels / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000601:surgery*
keywords: Mustard; VAD; bridge to transplant; congenital heart disease; systemic right ventricle; transposition