Center for Advanced Practice

Title

Systemic Atrioventricular Valve Excision and Ventricular Assist Devices in Pediatric Patients.

Publication Title

The Annals of thoracic surgery

Document Type

Article

PubMed ID

28821330

Abstract

BACKGROUND: Continuous-flow ventricular assist devices (CF VADs) designed for adults are increasingly used in pediatric patients. However, there is greater risk of device inflow obstruction as a result of size and anatomy.

METHODS: We reviewed all cases of systemic atrioventricular valve (AVV) excision with HeartWare HVAD (HeartWare, Framingham, MA) implantation in the systemic ventricle performed at our institution from November 2015 to May 2016.

RESULTS: AVV excision with CF VAD implantation was undertaken in 3 patients. Patient 1 was palliated in infancy, resulting in biventricular physiology with a systemic right ventricle, and presented at age 15 years with worsening ventricular dysfunction. After CF VAD implantation in the systemic ventricle and discharge to home, tricuspid valve obstruction to VAD inflow developed, and the patient and underwent tricuspid valve excision on postoperative day 52. Patients 2 and 3 were aged younger than 4 years, with a body surface area of 0.62 m

CONCLUSIONS: CF VAD implantation with AVV excision can successfully support complex pediatric patients in a wide range of size and anatomy (small chambers, systemic right ventricles). This technique may allow for CF VAD implantation in patients previously deemed too small for such support.

Keywords

Adolescent, Child, Preschool, Female, Heart Defects, Congenital, Heart Diseases, Heart Valves, Heart-Assist Devices, Humans, Male, Prosthesis Implantation, Retrospective Studies

DOI

10.1016/j.athoracsur.2017.05.038

Publication Date

1-1-2018

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