PULSATILE VENTRICULAR ASSIST DEVICE AS A BRIDGE TO TRANSPLANT FOR THE EARLY HIGH-RISK SINGLE VENTRICLE PHYSIOLOGY

Abstract Background The use of ventricular assist devices (VADs) as a bridge-to-transplant in patients with single ventricle physiology post-stage-one palliation has been associated with poor outcomes. We describe our center’s successful experience in the use of para-corporeal pulsatile VADs in the palliation of high-risk single ventricle physiology before or after the first stage of palliation with an impetus on pre-palliation implant. Methods This is a single-center retrospective review of univentricular patients implanted with the Berlin Heart EXCOR VAD. Our center’s approach includes early implantation of the Berlin Heart EXCOR with common atrial cannulation, a cardiac index between 3.5 to 5 L/min/m2, and a bivalirudin based anticoagulation regimen. Patient-related data were collected post-implant at week 1 and months 1, 2, and 3. Post-transplant data, including neurological outcomes, were collected. Results Nine patients were supported. Survival to discharge post-transplant was 83% (5/6) in patients bridged-to-transplant and 33% (1/3) in patients bridged-to-decision. Six patients had no prior palliation. Median hospital stay before implantation was 111 days for non-survivors vs 20 days for survivors. The need for ECMO and CPR in non-survivors vs survivors was 1/3 vs. 1/6 and 2/3 vs. 1/6, respectively. There were no major CNS complications except for one significant hemorrhagic event. The Pediatric Overall Performance Category score on follow up was normal to mild disability in 83% of survivors. Limitations include hemolysis and intermittent periods of infection and/or inflammation. Conclusions The use of pulsatile para-corporeal VADs is a feasible option as a bridge-to-transplant in the peri-stage-one high-risk single ventricle.