Mavroudis Constantine D, O'Connor Matthew J, Wittlieb-Weber Carol, Edelson Jonathan B, Edwards Jonathan J, Berger Justin H, Lin Kimberly Y, Rossano Joseph, Maeda Katsuhide
Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa.
JTCVS Tech. 2023 Nov 2;24:164-168. doi: 10.1016/j.xjtc.2023.10.022. eCollection 2024 Apr.
Infants with single ventricle heart disease and severe atrioventricular valve regurgitation have poor outcomes following conventional staged palliation. As such, ventricular assist device (VAD) placement along with hybrid stage 1 palliation has been proposed as a bridge to heart transplant. We present a novel surgical technique for VAD implantation concurrent with hybrid stage 1 that avoids cardiopulmonary bypass.
We performed a retrospective review of our institutional experience with this novel surgical technique.
Three patients (weight, 2.7-3.5 kg; age, 3 to 5 days) underwent hybrid stage 1 with VAD placement, consisting of bilateral 3.5-mm expandable polytetrafluoroethylene (PTFE) pulmonary artery bands, a ductal stent, a 6-mm Berlin Heart outflow cannula onto the main pulmonary trunk with a 10-mm graft, a 6-mm Berlin Heart outflow cannula onto the right atrium, and a 10-mL Berlin Heart pump. In patients with severe aortic arch hypoplasia or coarctation, a 4-mm PTFE graft was sewn from the VAD outflow graft to the innominate artery to protect coronary and cerebral perfusion. Procedures were performed off bypass with minimal blood product use. Patients were extubated on postoperative days 2, 2, and 5. There were no procedural complications. All patients were transferred out of the intensive care unit and demonstrated appropriate weight gain. Anticoagulation strategy was bivalirudin and antiplatelet therapy. The patients underwent transplantation after 149 days, 157 days, and 288 days of support.
Off-pump single ventricle VAD placement is technically feasible and can be done at the time of hybrid stage 1 palliation with minimal operative morbidity as a bridge to transplant.
患有单心室心脏病和严重房室瓣反流的婴儿在接受传统分期姑息治疗后预后较差。因此，有人提出将心室辅助装置（VAD）置入与一期混合姑息治疗相结合，作为心脏移植的桥梁。我们介绍一种新型手术技术，可在一期混合姑息治疗的同时植入VAD，避免使用体外循环。
我们对采用这种新型手术技术的机构经验进行了回顾性分析。
3例患者（体重2.7 - 3.5千克；年龄3至5天）接受了一期混合姑息治疗并置入VAD，包括双侧3.5毫米可扩张聚四氟乙烯（PTFE）肺动脉束带、导管支架、一根6毫米的柏林心脏流出插管经10毫米移植物置入主肺动脉干、一根6毫米的柏林心脏流出插管置入右心房以及一个10毫升的柏林心脏泵。对于主动脉弓严重发育不全或缩窄的患者，从VAD流出移植物至无名动脉缝合一根4毫米的PTFE移植物，以保护冠状动脉和脑灌注。手术在非体外循环下进行，血液制品使用量极少。患者分别在术后第2天、第2天和第5天拔除气管插管。无手术并发症。所有患者均转出重症监护病房，体重增加情况良好。抗凝策略为比伐卢定和抗血小板治疗。患者在接受支持治疗149天、157天和288天后接受了移植手术。
非体外循环下单心室VAD置入在技术上是可行的，可在一期混合姑息治疗时进行，作为移植桥梁，手术并发症极少。
