title: HeartWare Ventricular Assist Device Implantation in Patients With Fontan Physiology.
abstract: We aim to describe the clinical course of a series of patients with hypoplastic left heart syndrome and refractory systolic heart failure supported with a HeartWare ventricular assist device (HVAD) following Fontan palliation. This is a retrospective review of three consecutive patients supported with a HVAD following Fontan palliation through February 2016. Data include patient characteristics, operative variables, postimplantation hemodynamic/device parameters, event outcomes, and duration of HVAD support. Patient ages were 11.7, 13.5, and 17.5 years, respectively, at the time of HVAD implant. The duration of HVAD support was 148, 272, and 271 days, respectively, of which 86, 222, and 211 were outpatient days. Inflow cannula position was the morphologic right ventricle with depth adjustment and manipulation of the tricuspid subvalvar apparatus to ensure good inflow. Echocardiographic, hemodynamic, and noninvasive oximetric monitoring resulted in high RPM settings for all patients. Despite various complications, all patients were successfully transplanted and discharged home alive. We present three patients bridged to transplantation using the HVAD following Fontan palliation. We demonstrate potential for durable support with transition to outpatient care while awaiting heart transplantation in a subset of patients status post Fontan surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Bartlomiej R
authors.initials: BR
authors.lastname: Imielski
authors.affiliation: Department of Pediatrics, Section of Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Niebler
authors.affiliation: Department of Pediatrics, Section of Cardiology 3, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kindel
authors.affiliation: Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Woods
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D004452:Echocardiography; D018729:Fontan Procedure / Q000009:adverse effects; D006352:Heart Ventricles / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D019919:Prosthesis Implantation / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: -Heart transplantation; -Mechanical Circulatory Support; -heart-assist devices; -total cavopulmonary anastomosis; Congenital Heart Disease