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A Novel Surgical Approach to Mechanical Circulatory Support in Univentricular Infants
Avihu Z Gazit1, Orlando Petrucci2, Peter Manning2
1Division of Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri; Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Insights
A novel mechanical circulatory support technique offers feasible long-term solutions for infants with single-ventricle physiology after stage 1 palliation, improving outcomes and enabling recovery or transplantation.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Limited mechanical circulatory support options and poor outcomes historically exist for infants with single-ventricle physiology.
- A novel approach for long-term mechanical circulatory support in this vulnerable patient population is presented.
Purpose of the Study:
- To describe a new technique for long-term mechanical circulatory support in infants with single-ventricle physiology post-stage 1 palliation.
- To evaluate the feasibility and outcomes of this novel approach.
Main Methods:
- A single-center case series involving 7 infants with single-ventricle physiology after stage 1 palliation.
- Utilized modified pediatric cannulae implanted into the common atrium and ascending aorta/reconstructed neoaorta, powered by a centrifugal extracorporeal pump.
Main Results:
- Median support duration was 64 days (range, 35-99 days).
- One adverse neurologic event and bleeding requiring reoperation in 2 patients were observed.
- All patients received support for recovery, transplantation decision, or heart transplantation, with 43% successfully discharged home.
Conclusions:
- Long-term extracorporeal mechanical circulatory support is feasible in infants with single-ventricle physiology post-stage 1 palliation using this novel technique.
- The approach addresses challenges like high flow requirements and cannula stability, facilitating extubation, rehabilitation, and myocardial recovery.
Background:
Historically, the options for mechanical circulatory support in infants, particularly those with single-ventricle physiology, have been limited and outcomes have generally been poor. We report a new approach implemented for long-term support in a series of such patients.
Methods:
This study is a single-center case series of 7 patients with single-ventricle physiology after stage 1 palliation supported with mechanical circulatory support using a novel technique, between May 2014 and September 2015. Our technique included modification and implantation of commercially available pediatric cannulae into the common atrium and the ascending aorta or reconstructed neoaorta and utilization of a centrifugal extracorporeal pump.
Results:
Median circulatory support duration was 64 days (range, 35 to 99). One adverse neurologic event was observed in 1 patient, and bleeding requiring reoperation in 2 patients. Support to recovery, decision, or heart transplantation was accomplished in all cases. Of all patients, 43% were successfully discharged home.
Conclusions:
Our experience shows that long-term extracorporeal mechanical circulatory support of patients with underlying single-ventricle physiology after stage 1 palliation is feasible utilizing our technique. This approach overcomes several major challenges encountered in these patients, such as high flow requirement and stability of the cannulae, and allows extubation, rehabilitation, and at times, myocardial recovery.
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