Four-year paracorporeal left ventricular assist device (LVAD) support for heart failure after Rastelli operation

It is well known that heart failure can occur after a conventional Rastelli operation (using an anatomical right ventricle as a systemic ventricle) in patients with congenitally corrected transposition of the great arteries (CCTGA). At present, heart transplantation (HTx) is the only definitive therapy known to save such patients. The left ventricular assist device (LVAD) has been employed for patients presenting with acute deterioration of chronic heart failure as a bridge to transplantation when early HTx is not feasible. LVAD implantation in postoperative cases and/or in patients with dextrocardia is often difficult because of the complex anatomy. We report the case of a 26-year-old male patient with CCTGA who presented with heart failure after a conventional Rastelli operation and in whom paracorporeal LVAD implantation was undertaken for the management of right (systemic) ventricular failure. The patient recovered from the heart failure and remained on the HTx list for approximately 4 years with LVAD support.