Rosseel Thomas, Santens Beatrice, Droogne Walter, Voros Gabor, Van Cleemput Johan, Van Aelst Lucas, Budts Werner, Jacobs Steven, Van De Bruaene Alexander, Meyns Bart
Department of Cardiology, University Hospital Leuven, Leuven, Belgium.
Department of Cardiac Surgery, University Hospital Leuven, Leuven, Belgium.
Int J Cardiol Congenit Heart Dis. 2022 Mar 29;8:100365. doi: 10.1016/j.ijcchd.2022.100365. eCollection 2022 Jun.
Patients with a systemic right ventricle (sRV) have a high risk of developing heart failure (HF), with heart transplantation as the only long-term treatment option. Unfortunately, more than half of sRV patients have pulmonary hypertension (PH) which may impact the decision to opt for heart-only transplantation. Moreover, an increased scarcity of donor hearts prolongs time to transplantation, increasing the probability of dying on the waiting list. Hence, for selected sRV patients, a ventricular assist device (VAD) could provide a solution to bridge the time to transplantation. This case series aimed at evaluating all patients with a sRV who received a VAD at our institution, with a focus on technical aspects of VAD implantation and invasive hemodynamics prior to VAD implantation and after heart transplantation. In total 5 patients with a sRV who received a VAD at our institution were included. All five were male with a median age of 38 years (19-49) at the time of VAD implantation. All patients were subsequently successfully transplanted. Pulmonary artery (PA) pressures were significantly elevated prior to VAD implantation and decreased significantly after VAD implantation and subsequent heart transplantation. With this case series we highlight the ability of a VAD to support the failing sRV, as well as to reduce PA pressures, making patients eligible for heart-only transplantation.
系统性右心室（sRV）患者发生心力衰竭（HF）的风险很高，心脏移植是唯一的长期治疗选择。不幸的是，超过一半的sRV患者患有肺动脉高压（PH），这可能会影响仅选择心脏移植的决定。此外，供体心脏的稀缺性增加延长了移植时间，增加了在等待名单上死亡的可能性。因此，对于选定的sRV患者，心室辅助装置（VAD）可以提供一种解决方案，以缩短至移植的时间。本病例系列旨在评估在我们机构接受VAD的所有sRV患者，重点关注VAD植入的技术方面以及VAD植入前和心脏移植后的有创血流动力学。共有5例在我们机构接受VAD的sRV患者被纳入。所有5例均为男性，VAD植入时的中位年龄为38岁（19 - 49岁）。所有患者随后均成功接受移植。VAD植入前肺动脉（PA）压力显著升高，VAD植入及随后心脏移植后显著降低。通过本病例系列，我们强调了VAD支持功能衰竭的sRV以及降低PA压力的能力，使患者有资格仅接受心脏移植。
