How I Do It: Neonatal And Infant Total Artificial Heart Implantation Niall Khan, MB BCh BAO MCh, Sassan Hashemi, Marco Ricci, David Cooper, David Morales. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Introduction: We present the case of a 5-month-old male with a history of Noonan’s syndrome and severe hypertrophic cardiomyopathy. The child presented to our institution with cardiogenic shock requiring intubation and mechanical ventilation. The child was referred for durable mechanical support.Description: A median sternotomy was performed. Given the severe cardiomegaly and degree of hypertrophy, we did not feel it would be feasible to implant a Berlin Heart biventricular assist device. We thus proceeded towards a total artificial heart implantation using Berlin Heart pumps. Cardiectomy was carried out and patches were then sewn to the mitral and tricuspid annuli. Ringed PTFE grafts were sewn to these patches for the inflow cannulae. Non-ringed PTFE grafts were sewn to the aorta and pulmonary artery for the outflow cannulae and the device was set up. The child did well but notably developed inflow obstruction in the post-operative period due to inward migration of the cannula requiring operative correction. The child was transplanted after four months on the device and is currently recovering in the intensive care unit.Conclusions: This represents the second case of total artificial heart implantation in an infant performed at our institution. The first child has since been transplanted and discharged home. This technique has previously been described in case reports and very small case series. This video provides a detailed description of our approach and explores key technical pitfalls for centers intending to adopt the technique.
