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Updated: Feb 25, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
First-in-Human Closed-Chest Transcatheter Superior Cavopulmonary Anastomosis
Kanishka Ratnayaka1, John W Moore2, Rodrigo Rios2
1Division of Cardiology, Rady Children's Hospital, Department of Pediatrics, University of California San Diego, San Diego, California; Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Insights
A novel transcatheter procedure offers a less invasive alternative to open-heart surgery for complex congenital heart disease, specifically for single-ventricle patients needing a bidirectional Glenn operation equivalent.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Congenital Heart Disease Treatment
Background:
- Complex congenital heart defects often necessitate open-heart surgery.
- Single-ventricle patients typically undergo staged surgeries with significant risks.
- A less invasive, nonsurgical transcatheter alternative is highly desirable.
Observation:
- A novel technique for catheter-only, closed-chest, large-vessel anastomosis was developed.
- Preclinical testing spanned over a decade, focusing on endovascular stent-based anastomosis.
- A patient-specific 3D printed heart model and CT scans were used for procedural rehearsal.
Findings:
- The first-in-human, fully percutaneous superior cavopulmonary anastomosis was successfully performed.
- A 35-year-old woman with severe cyanosis and functional single ventricle showed clinical improvement.
- The patient recovered uneventfully and remained improved at 6 months post-procedure.
Implications:
- This transcatheter approach may become a viable alternative to open-heart surgery for single-ventricle palliation.
- It offers a potentially lower-risk option for patients with complex congenital heart disease.
- Further research could establish this as a standard treatment for specific congenital heart conditions.
Background:
In the care of patients with congenital heart disease, percutaneous interventional treatments have supplanted many surgical approaches for simple lesions, such as atrial septal defect. By contrast, complex congenital heart defects continue to require open-heart surgery. In single-ventricle patients, a staged approach is employed, which requires multiple open-heart surgeries and significant attendant morbidity and mortality. A nonsurgical transcatheter alternative would be attractive.
Objectives:
The authors sought to show the feasibility of catheter-only, closed-chest, large-vessel anastomosis (superior vena cava and pulmonary artery [PA] or bidirectional Glenn operation equivalent) in a patient.
Methods:
In preclinical testing over a decade, the authors developed the techniques and technology needed for nonsurgical crossing from a donor (superior vena cava) to a recipient (PA) vessel and endovascular stent-based anastomosis of those blood vessels. The authors undertook this transcatheter approach for an adult with untreated congenital heart disease with severe cyanosis and significant surgical risk. They rehearsed the procedure step by step using contrast-enhanced cardiac computed tomography and a patient-specific 3-dimensional printed heart model.
Results:
The authors describe a first-in-human, fully percutaneous superior cavopulmonary anastomosis (bidirectional Glenn operation equivalent). The patient, a 35-year-old woman, was homebound due to dyspnea and worsening cyanosis. She was diagnosed with functional single ventricle and very limited pulmonary blood flow. The heart team believed surgical palliation conferred high operative risk due to the patient's complete condition. With the percutaneous procedure, the patient recovered uneventfully and remained improved clinically after 6 months.
Conclusions:
This procedure may provide a viable alternative to one of the foundational open-heart surgeries currently performed to treat single-ventricle congenital heart disease.
