Gyoten Takayuki, Rojas Sebastian V, Fox Henrik, Schramm René, Hakim-Meibodi Kavous, Ruiz-Cano Maria, Gummert Jan F, Morshuis Michiel, Sandica Eugen
Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany.
Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Eur J Cardiothorac Surg. 2020 Nov 23. doi: 10.1093/ejcts/ezaa373.
Clinical experience with continuous flow ventricular assist devices (VADs) in patients with transposition of the great arteries (TGA) including dextro-TGA and congenitally corrected TGA is rare, and indications as well as potential benefits or specific hurdles remain unclear. Therefore, our goal was to report on our experience regarding VAD therapy in adult patients with TGA as a bridge to candidacy.
We performed a single-centre retrospective study of all adult patients with TGA with systemic right ventricular failure who had continuous flow VAD implants between 2010 and 2018. Study end points were all causes of death, major cardiac and cerebrovascular adverse events or pump thrombosis. Follow-up continued until the time of the heart transplant.
A total of 6 patients (4 men) had a continuous flow VAD implanted in the context of a failing systemic right ventricle (dextro-TGA after the Mustard procedure: n = 3; congenitally corrected TGA: n = 3). Demographics: mean age 32 ± 5.7 years; median Interagency Registry for Mechanically Assisted Circulatory Support: level II (range 1-4), mean pulmonary artery 48 ± 13 mmHg, mean pulmonary vascular resistance 5.6 ± 3.5 Wood units. Postoperative data: intensive care unit stay: 16 ± 9.7 days; in-hospital survival: 100%; no early VAD-related complications occurred. Mean follow-up: 33 ± 18 months; persistent left-side paresis: n = 1; minor (non-disabling) stroke: n = 2. Post-VAD pulmonary artery: 19 ± 3.4 mmHg; P < 0.005; post-VAD pulmonary resistance: 2.2 ± 0.55 Wood units; P = 0.066. Four patients had heart transplants after a mean waiting time of 30 months after the VAD was implanted; 2 patients are still on the waiting list (waiting time: 52 and 24 months).
Continuous flow VAD therapy is a feasible therapeutic option in adult patients with TGA and a failing systemic right ventricle as a bridge to candidacy and a bridge to a heart transplant.
连续血流心室辅助装置（VAD）在大动脉转位（TGA）患者（包括右位型TGA和先天性矫正型TGA）中的临床经验很少，其适应症以及潜在益处或特定障碍仍不明确。因此，我们的目标是报告我们在将VAD治疗用于成年TGA患者作为候选资格桥梁方面的经验。
我们对2010年至2018年间所有植入连续血流VAD的患有系统性右心室衰竭的成年TGA患者进行了一项单中心回顾性研究。研究终点为所有死亡原因、主要心脏和脑血管不良事件或泵血栓形成。随访持续至心脏移植时。
共有6例患者（4例男性）在系统性右心室功能衰竭的情况下植入了连续血流VAD（Mustard手术后的右位型TGA：n = 3；先天性矫正型TGA：n = 3）。人口统计学数据：平均年龄32±5.7岁；机构间机械辅助循环支持注册中心（Interagency Registry for Mechanically Assisted Circulatory Support）中位数：II级（范围1 - 4），平均肺动脉压48±13 mmHg，平均肺血管阻力5.6±3.5伍德单位。术后数据：重症监护病房停留时间：16±9.7天；院内生存率：100%；未发生早期VAD相关并发症。平均随访时间：33±18个月；持续性左侧轻瘫：n = 1；轻度（非致残性）中风：n = 2。VAD植入后肺动脉压：19±3.4 mmHg；P < 0.005；VAD植入后肺血管阻力：2.2±0.55伍德单位；P = 0.066。4例患者在VAD植入后平均等待30个月后接受了心脏移植；2例患者仍在等待名单上（等待时间：52个月和24个月）。
连续血流VAD治疗对于患有TGA且系统性右心室功能衰竭的成年患者作为候选资格桥梁和心脏移植桥梁是一种可行的治疗选择。
