With the substantial growth of pediatric ventricular assist device (VAD) support,
there has been an expansion of the target population towards more complex patients,
including congenital heart disease (CHD) with single ventricle (SV) physiology. The
outcomes of Stage I and Stage II SV-CHD patients on VAD support from the Pedimacs
database are poor, with less than 50% survival on VAD by the 3-month mark in both.
The primary objective of this article is to describe the current state of VAD support
for the failing Stage I and II SV-CHD circulation, to provide insight into potential
areas of outcome improvement. We reviewed the published literature in the form of
database and registry reports as well as single-center studies to discuss the outcomes
of Stage I and Stage II SV-CHD patients on VAD support. Registry-based studies suggest
that VAD support for the failing Stage I and Stage II SV-CHD circulations is challenging.
However, the more promising outcomes in several single-institutional reports for both
Stage I and Stage II SV-VAD indicate that the grim picture from the databases does
not reflect the best outcomes that are possible to be achieved, potentially at experienced
centers with higher volumes. Areas of future study and potential improvement including
timely initiation of VAD support in the cohort of patients expected to not be a candidate
for standard SV palliations, pump selection and the benefits of continuous-flow devices,
and the decision-making for setting up the optimum circulation for VAD support, be
it Fontan completion if feasible or takedown to shunt physiology.
Keywords
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Article info
Footnotes
From: Texas Children's Hospital, Baylor College of Medicine, Houston, TX
Conflict of Interest: Dr Puri reports no conflicts of interest. Dr Adachi reported consultant/proctor for Berlin Heart Inc, Medtronic Inc, Abbott Inc, Jarvik Inc, BiVACOR Inc, and Sony-Olympus Medical Solutions, Inc.
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