Assessment of Ventricular Assist Device Placement and Function

Heart failure (HF) has reached endemic proportions worldwide, and its burden is expected to exponentially grow in the next decade. HF is a progressive syndrome that leads to end-stage circulatory failure with end organ dysfunction. Due to a severe shortage of organs, heart transplantation is not able to meet the growing numbers of advanced HF patients. To fill this void, mechanical circulatory support with ventricular assist device (VAD) placement is now the mainstay for bridging HF patients to heart transplantation or serving as destination therapy (DT) for those not eligible for transplantation. Major challenges remain in the expansion of VAD placement in HF patients with congenital heart disease (CHD), mainly related to the complex and unusual spatial orientation of cardiac chambers and vascular structures. This chapter will review the utility and experience of VAD placement in CHD patients with HF and the potential role of three-dimensional (3D) modeling in preoperative planning to overcome anatomical barriers. In addition, we will describe how 3D modeling may aid in visualizing cannula malposition to prevent suboptimal device operation.