Thorac Cardiovasc Surg 2016; 64 - ePP68
DOI: 10.1055/s-0036-1571934

Left-Ventricular Assist Device (LVAD) and Aortopulmonary Shunt Creation to Support the Failing Univentricular Heart

P. Angleitner 1, C. Herbst 1, E. Kitzmüller 2, J. Riebandt 1, T. Schlöglhofer 1, G. Laufer 1, I. Michel-Behnke 2, D. Zimpfer 1
  • 1Medical University of Vienna, Department of Cardiac Surgery, Vienna, Austria
  • 2Medical University of Vienna, Department of Pediatric Cardiology, Vienna, Austria

Objectives: We report on a 15-year-old patient with failing single ventricle palliation admitted for cardiac transplantation for failing univentricular palliation after tricuspid atresia Ib. So far, a modified Blalock-Taussig shunt and a Glenn anastomosis were performed. Invasive evaluation revealed elevated pulmonary pressure, small pulmonary arteries and extensive pulmonaryarteriovenous fistulas (PAVM) formation in the left lung. Overall, the patient was considered non-transplantable. An alternative treatment strategy with implantation of a Heartware® ventricular assist device together with placement of a systemic shunt to the left lung to promote (1) regression of PAVM by re-establishing hepatic flow to the lung and (2) growth of the pulmonary vasculature, was developed.

Methods: A Heartware® HVAD ventricular assist device was implanted in the morphological left ventricle. Additionally, a subtotal separation of right- and left-pulmonary artery was created by narrowing of the pulmonary artery bifurcation, leaving the right lung to the Glenn circulation and the left lung to perfusion through the 6 mm aortopulmonary shunt.

Results: The patient was extubated on the first postoperative day and recovered uneventfully. The pump was set at 3000 rpḿs providing the patient with 6.5 to 7 L of additional cardiac output. Saturation increased from 30–40% before the procedure to 65–75% thereafter.

Conclusion: In failing single ventricle palliations, ventricular support by a Heartware® HVAD together with implantation of an aortopulmonary shunt and pulmonary artery separation ameliorates heart failure and cyanosis. This concept serves as a bridge to heart transplant or destination therapy in end stage univentricular CHD.