title: Mechanical Circulatory Support as Bridge to Transplantation for the Failing Single Ventricle.
abstract: BACKGROUND
  Circulatory failure necessitating cardiac transplantation will ultimately develop in many patients with functional single-ventricle physiology. Interest in the use of mechanical circulatory support (MCS) in this population is growing.
  
  
  METHODS
  This was a retrospective case series of patients with functional single-ventricle physiology who underwent MCS with a ventricular assist device or a total artificial heart as a bridge to cardiac transplantation between January 2006 and December 2014. Baseline demographics, intraoperative data, postoperative complications, and outcome data were collected from the medical record.
  
  
  RESULTS
  MCS was used in 5 patients: HeartWare ventricular assist device (HeartWare International, Framingham, MA) in 1 patient, SynCardia total artificial heart (SynCardia Systems, Tucson, AZ) in 1, Thoratec Paracorporeal ventricular assist device (Thoratec Corp, Pleasanton, CA) in 1, and the Berlin Heart EXCOR (Berlin Heart Inc, The Woodlands, TX) in 2. The mean age at MCS was 12 ± 8 years. There were 2 early deaths at 12 and 28 days after MCS: 1 patient died of multiorgan system failure and 1 of neurologic injury. Overall, neurologic complications occurred in 3 patients (60%), and 1 patient (20%) required renal replacement therapy. Three patients (60%) underwent successful cardiac transplantation. The median time on the waiting list was 59 days (interquartile range, 18 to 126 days), and the median duration of MCS was 60 days (interquartile range, 28 to 93 days). At the time of transplant, all 3 patients were ambulatory, without the need for mechanical ventilation, and end-organ dysfunction had resolved. The 3 patients who received transplants were discharged from the hospital and were alive at an average follow-up of 9 ± 14 months.
  
  
  CONCLUSIONS
  MCS can be successfully used as a bridge to transplantation in patients with a failing single-ventricle circulation. Use of MCS can allow for resolution of end-organ dysfunction and rehabilitation, leading to improved outcomes in this difficult population.
authors.affiliation: Department of Cardiac Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: George J
authors.initials: GJ
authors.lastname: Arnaoutakis
authors.affiliation: Department of Cardiac Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Blitzer
authors.affiliation: Department of Cardiac Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fuller
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah.
authors.forename: Aaron W
authors.initials: AW
authors.lastname: Eckhauser
authors.affiliation: Division of Cardiac Anesthesiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Montenegro
authors.affiliation: Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Rossano
authors.affiliation: Department of Cardiac Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: gaynor@email.chop.edu.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult