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Evolving understanding of total artificial heart support of young infants and children

Published:September 28, 2019DOI:https://doi.org/10.1016/j.jtcvs.2019.09.063

      Abstract

      Background

      We have developed a new method of total artificial heart (TAH) support for young patients, and here share our preliminary results and evolving understanding.

      Methods

      This report is a retrospective chart review of all patients <10 kg who received a TAH at our institution from May 2017 to the time of this report.

      Results

      Our cohort includes 5 patients. Two had single-ventricle circulation, 1 of whom had undergone a Glenn procedure and was revised back to a Sano shunt. Four were on extracorporeal life support for longer than 10 days, 3 with an open chest. In these 3 patients, the TAH was a salvage operation. Centrifugal pumps were used for 2 patients and pulsatile pumps for 3 patients. Three patients survived to transplantation and discharge, with support times of 79, 44, and 96 days; in these patients, the duration of follow-up from discharge to the time of this report was 687, 19, and 8 days, respectively, and all patients were well. For the pulsatile pumps, in the first patient we placed valved conduits for inflow connections. For the second patient, we omitted the valved conduits and oversized the pumps to avoid full fill; yet, despite our best efforts, full fill occurred frequently, and thus we converted to a systemic centrifugal pump.

      Conclusions

      Our method of TAH support can be tailored to provide effective support of carefully selected young children with single or biventricular physiology. In our opinion, for pulsatile pumps, oversizing the pump and using valved inflow conduits may be important adjuncts to achieve effective support.

      Key Words

      Abbreviations and Acronyms:

      BiVAD (biventricular assist device), ECLS (extracorporeal life support), LVAD (left ventricular assist device), PTFE (polytetrafluoroethylene), TAH (total artificial heart), VAD (ventricular assist device)
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