Patients With Bidirectional Glenn Physiology Can Be Successfully Bridged To Transplantation With Ventricular Assist Devices
Michael C. Monge, MD1, Philip T. Thrush, MD1, Salem Argaw, BA2, Allison Reichhold, APN1, Anna Joong, MD1.
1Ann & Robert H Lurie Childrens Hospital of Chicago, Chicago, IL, USA, 2Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Objective(s): Ventricular assist device (VAD) use in pediatric patients with single ventricle anatomy presents challenges due to small size and complex anatomy and physiology. Published outcomes of VAD use in patients with bidirectional Glenn physiology (BDG) are poor. We describe our strategy of supporting BDG patients with VADs as bridge-to-transplantation (BTT).
Methods: We performed a retrospective, single institution review of patients with BDG requiring VAD support between 2012-2021. Clinical characteristics, adverse events, and survival are reported.
Results: During the study period, 10 patients with BDG underwent VAD implantation. Age at VAD was 2.9±1.8 years. Average weight was 12.3±4.4kg. Pre-implant, 4 patients were intubated and 1 was on ECMO. Patients were supported for 61±78 days. In the early era (2012-2015, n=4), the TandemHeart was implanted and in the late era (2019-2021, n=6), initial pump was the CentriMag, with 3 patients successfully transitioned to Berlin Heart Excor. Average cardiac index was 5.0±1.8LPM/m2. In the early era (heparin anticoagulation), 2/4 had an ischemic stroke, and in the late era (bivalirudin anticoagulation) 1/6 had an ischemic stroke and 1/6 had a small subdural hematoma. One patient required CRRT. Four patients required temporary oxygenator (3 in early era). Seven patients (70%) were BTT, 2 remain alive on device, and 1 died after 35 days of support. All transplanted patients are alive with average follow-up of 4.0±2.6 years.
Conclusions: Patients with BDG can successfully be BTT with VAD with low morbidity and mortality. There has been a trend towards decreased stroke incidence in the current era.
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