Fahnhorst Sarah E, Brandewie Katie, Perry Tanya, Opotowsky Alexander R, Lubert Adam M, Lorts Angela, Morales David L S, Villa Chet R
From the Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
ASAIO J. 2023 Oct 1;69(10):956-961. doi: 10.1097/MAT.0000000000001986. Epub 2023 May 18.
Ventricular assist devices are increasingly used for patients with single ventricle physiology. We describe the use of durable, continuous flow, single ventricular assist device (SVAD) therapy in Fontan circulatory failure patients. Retrospective, single-center review of patients with Fontan circulation implanted with a SVAD between 2017 and 2022. Patient characteristics and outcomes were obtained by chart review. Nine patients underwent SVAD implantation (median age 24 years). Most patients had a total cavopulmonary connection; one had an atriopulmonary Fontan. Five patients had a systemic right ventricle. SVAD was most often utilized as bridge to candidacy (67%). Eight patients had at least moderate systemic ventricular systolic dysfunction. SVAD support continued for a median of 65 days (longest duration, 1,105 days) and one patient remains on support at time of submission. Of five patients discharged home, median length of stay after SVAD was 24 days. Six patients were transplanted (median 96 days from SVAD). Two patients died from pretransplant multisystem organ failure before transplant. All transplanted patients remain alive (median time since transplant 593 days). Continuous flow SVAD therapy can be effective for patients with Fontan circulatory failure and systolic dysfunction. Further studies should investigate feasibility and optimal SVAD timing with more advanced Fontan associated end-organ dysfunction.
心室辅助装置越来越多地用于单心室生理的患者。我们描述了在Fontan循环衰竭患者中使用耐用的、连续血流的单心室辅助装置（SVAD）治疗的情况。对2017年至2022年间植入SVAD的Fontan循环患者进行回顾性单中心研究。通过查阅病历获取患者特征和结局。9例患者接受了SVAD植入（中位年龄24岁）。大多数患者进行了全腔肺连接；1例为心房肺Fontan手术。5例患者有体循环右心室。SVAD最常被用作过渡到符合移植条件的桥梁（67%）。8例患者至少有中度体循环心室收缩功能障碍。SVAD支持的中位时间为65天（最长持续时间为1105天），1例患者在提交本文时仍在接受支持。5例出院回家的患者，SVAD术后中位住院时间为24天。6例患者接受了移植（自SVAD植入后的中位时间为96天）。2例患者在移植前死于移植前多系统器官衰竭。所有移植患者均存活（自移植后的中位时间为593天）。连续血流SVAD治疗对Fontan循环衰竭和收缩功能障碍患者可能有效。进一步的研究应探讨在更晚期Fontan相关终末器官功能障碍情况下SVAD的可行性和最佳使用时机。
