Total Artificial Heart Implantation Using Two Rotary Blood Pumps in a 4-Year-Old Child

Background: Implantation of ventricular assist devices has become a standard treatment of terminal heart failure in adult patients. In certain indications, however, total artificial heart (TAH) placement may be favorable. Considering the limited availability of dedicated TAH devices, implantation of two rotary blood pumps (RBPs) in a TAH setup opposes a feasible alternative. Transfer of this technique to the pediatric population has previously not been reported, primarily due to limited size compatibility of available devices.

Method: We report the case of a 4-year-old girl (body surface area: 0.7 m²) receiving two RBPs as TAH after developing posttransplant lymphoproliferative disease (PTLD), EBV-positive myocarditis, and severe graft vasculopathy following an initial orthotopic heart transplantation at 3 years of age. Additionally, a prolonged episode of CPR necessitated initiation of extracorporeal membrane oxygenation (ECMO). Since no signs of myocardial recovery could be observed several days after ECMO implantation, permanent mechanical support was opted for as bridge to cardiac retransplantation. An augmented PTLD treatment would be achieved by replacement of the previously transplanted heart with a TAH in combination with continued standard rituximab therapy. TAH implantation comprised resection of both ventricles and atrioventricular valve leaflets, followed by insertion of two RBPs into two 20-mm inflow grafts anastomosed to the atrioventricular plane.

Results: TAH implantation using two RBPs was successfully performed with planned delayed sternal closure on postoperative day (POD) 1. In the postoperative course, two reinterventions for drainage of intrathoracic hemorrhaging were necessary. Furthermore, an initially prolonged hypoventilation of the left lung was effectively remedied using noninvasive ventilation and high-flow oxygen therapy. On POD 28, an episode of pump thrombosis in the left-sided device was resolved by two courses of thrombolytic therapy. Following demonstration of complete PTLD remission, the patient was successfully retransplanted after 71 days of TAH support.

Conclusion: Implantation of two rotary blood pumps is feasible in small pediatric patients in a total artificial heart setup. Application of this technique may grant bridging to retransplantation in complex cases of pediatric terminal heart failure.

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Artikel online veröffentlicht:
28. Januar 2023