Cannulation strategy for centrifugal-flow ventricular assist device implantation late after arterial switch operation

The field of paediatric ventricular assist device (VAD) support is growing rapidly. Among paediatric patients, those with complex congenital heart disease represent a challenging population for VAD support. This report describes a patient with a remote history of an arterial switch operation for d-transposition of the great arteries who developed ischaemic cardiomyopathy necessitating centrifugal-flow VAD support as a bridge to cardiac transplantation. Because of the unique anatomy and the complicated vascular situation, implantation of the centrifugal-flow VAD and subsequent explantation for cardiac transplantation required modifications to the standard surgical approach. The details of surgical pitfalls encountered are described.