Implantation Of A Heartmate 3 Ventricular Assist Device In A 21 Kg Pediatric Patient With Fontan Failure
David Ranney, Alyssa Habermann, James Meza, Joseph Turek, Andrew Lodge, Travis Vesel, Jacob Schroder, Nicholas Andersen.
Duke University, Durham, NC, USA.
Objective(s): The HeartMate 3 ventricular assist device (HM3-VAD) is gaining popularity in adults due to a favorable risk profile. However, reports of HM3-VAD use in children are limited, potentially due to concerns with the device size. Here, we report successful use of a HM3-VAD as a bridge to transplantation in a child with Fontan failure.
Methods: A 21 kg (body surface area 0.84), 8-year old male with Fontan failure was listed for heart transplantation on home inotropes. Due to progressive deterioration, urgent VAD implantation was considered necessary. The decision was made to attempt HM3-VAD placement given the favorable risk profile of the device and potential need for long-term support while awaiting transplantation.
Results: HM3-VAD implantation was performed using the standard adult sewing ring. The tricuspid valve and papillary muscles were completely excised from the ventricular cavity, to prevent inflow obstruction. Adhesions from prior left diaphragm plication were widely mobilized from the chest wall, to create space for the device in the left pleural space. Outflow graft and driveline implantation were per routine. In the acute period, VAD function appeared excellent with a reduction in Fontan pressures, and improved kidney and liver function. Reoperation was required once to rule out tamponade and twice to evacuate a recurrent right hemothorax. The patient is now extubated, ambulating, and actively listed for heart transplantation with preserved end-organ function.
Conclusions: This report demonstrates the feasibility of HM3-VAD implantation in a 21 kg child, suggesting HM3-VAD size is not a prohibitive limitation at this weight.