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Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
Access to the native atria following conduit total cavopulmonary anastomosis
Robert L Petersen1, Saar Danon1, Saadeh Jureidini1
1Saint Louis University School of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, and Cardinal Glennon Children's Hospital, St Louis, MO, 63104.
Insights
Trans-thoracic and trans-conduit puncture provide atrial access for interventions after Fontan surgery. These minimally invasive techniques successfully enabled various procedures, avoiding repeat open-heart surgery.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Catheter access to the atria is crucial for interventions in patients with Fontan circulation.
- Existing methods may be limited, necessitating alternative approaches for trans-atrial procedures.
Observation:
- A novel technique involving trans-thoracic and trans-conduit puncture was used in five patients (ages 7-28) between 2009-2014.
- Three patients underwent trans-thoracic puncture, and two had trans-conduit puncture.
Findings:
- Successful atrial access was achieved in all five patients using both puncture methods.
- Interventions included lead placement, venous occlusion, pulmonary valve closure, and atrial tachycardia ablation.
Implications:
- Trans-conduit puncture and trans-thoracic access offer a less invasive alternative for atrial interventions in Fontan patients.
- These approaches may reduce the need for subsequent open-heart surgeries, improving patient outcomes.
Objectives:
We describe the use of trans-thoracic and trans-conduit puncture to access the atria and perform interventional procedures in patients who have undergone conduit total cavopulmonary anastomosis.
Background:
Catheter access to the atria following intra or extra-cardiac Fontan is desirable when there is a need for trans-atrial interventions.
Methods:
Between 2009 and 2014, 5 patients ages 7 to 28 years underwent this approach; three trans-thoracic and 2 trans-conduit punctures. Various therapeutic aims were achieved. Included are: placement of pacing wire in the left atrial appendage, access to re-canalized left superior vena cava via the coronary sinus for device occlusion eliminating cyanosis, access with subsequent device closure of a dormant pulmonary valve thought to be the nidus of an embolic event, and access to the atria for ablation of an atrial tachycardia.
Results:
Entry to the atria was successful in all five patients with either trans-thoracic access or trans-conduit puncture with subsequent intended intervention performed successfully.
Conclusions:
Trans-conduit puncture and trans-thoracic access may allow therapeutic procedures which mitigate the need for further open heart surgery. © 2017 Wiley Periodicals, Inc.
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