130 Kg Of Failing Fontan - LVAD Plus ECLS To New Method Of TAH
Ronald K. Woods, MD, PhD, Lyle Joyce, MD, PhD.
Medical College Wisconsin, Milwaukee, WI, USA.
Objective(s): To share my nightmare case of a very complex patient with failing Fontan physiology.
Methods: Retrospective chart review.
Results: Patient was a 29 year-old, 130 kg, listed for heart liver transplant due to failing Fontan and cirrhosis. After several admissions for heart failure (mixed), we placed a continuous flow LVAD with a 6mm PTFE conduit from the PA to the pulmonary venous atrium as a means of attempting to decompress the systemic venous circulation(massive collateral return noted during case). Despite flows of over 9 L per min, mean arterial pressure was inadequate. ECLS via the right neck provided a total flow of 13 L per min, resulting in much better systemic pressure. At catheterization for failure to improve, Fontan and end-diastolic pressures were in the range of 20-23 mm Hg, and only 2 somewhat large collaterals were noted (embolized). One month after LVAD implantation, we converted to salvage total artificial heart (TAH - Syncardia) using a novel atrial septation method for creation of the neo right and left atria. We achieved excellent support; however, the patient failed to improve and care was withdrawn. (More details of the nightmares to be shared at time of case presentation.)
Conclusions: A nightmare, terrible case resulting in death of the patient taught us a potentially important innovation that greatly simplified implanting a TAH in a Fontan patient.