Back to 2024 Abstracts
Mechanical Support Of The Failing Glenn Circulation: Impact Of High Flow Cardiopulmonary Bypass And Ventricular Assist
L. Mac Felmly, MD, Heather Henderson, MD, Andrew Savage, MD, Minoo N. Kavarana, MD.
Medical University of South Carolina, Charleston, SC, USA.
Objective(s): Ventricular assist device (VAD) support in failing Glenn circulation has historically yielded poor outcomes, prompting programs to seek alternative strategies such as Glenn takedown to a systemic-to-pulmonary artery shunt or Fontan conversion. We recently employed a strategy utilizing high VAD flow to support patients with failing Glenn physiology without surgically altering their pulmonary blood flow (PBF).
Methods: This study is a single center retrospective review of patients who had previously undergone a bidirectional Glenn (cavopulmonary connection) for single ventricle heart disease, and subsequently developed refractory heart failure requiring VAD support.
Results: Four patients, three with hypoplastic left heart syndrome and one with tricuspid atresia, underwent Berlin VAD placement on high-flow cardiopulmonary bypass (>3.0 L/min/m2). One patient underwent ventricular apical cannulation and three patients underwent right atrial cannulation. No patient had accessory PBF. Due to hypoxia two patients required VA ECMO to separate from bypass, and were subsequently transitioned to VAD at 68 and 80 hours. VAD flows have been maintained at a mean indexed flow of 4.7 L/min/m2. There has been no mortality, major bleeding, neurologic or renal injury, and all patients demonstrated improved growth. One patient was successfully transplanted after 44 days of VAD support. The remaining patients are currently well supported in room air awaiting transplant. This represents a cumulative 419 days of VAD support.
Conclusions: Ventricular assist device support of the failing Glenn circulation can be successfully and safely achieved without Glenn takedown, shunt placement, or Fontan conversion by utilizing a high flow VAD strategy.
Back to 2024 Abstracts
