Two Pumps for Single Ventricle: Mechanical Support for Establishment of Biventricular Circulation

A 31-year-old patient with a univentricular heart and double-inlet left ventricle, moderate pulmonary stenosis, and severe mitral valve regurgitation experienced irreversible heart failure after mitral valve replacement. "Biventricular" mechanical circulatory support was initiated. The systemic circulation was supported using the HeartWare ventricular assist device (HVAD) (HeartWare, Framingham, MA) pump in the usual manner. The second pump was inserted into the right atrium and connected to the pulmonary artery after closure of the pulmonary valve and atrial separation. This solution allowed optimal circulatory support, reduction of pulmonary resistance, and normal peripheral oxygen saturation. Thus the patient was listed for heart transplantation.