Continuous Flow Ventricular Assist Device Implantation in Non Dilated Cardiomyopathy Pediatric Patients Using Complimentary 3D Techniques

Purpose Continuous flow ventricular assist devices (CFVAD) are increasingly being used in pediatric patients. We present our technique using preoperative virtual fit using 3D imaging and intraoperative 3D printed CFVAD model to assess fit in pediatric patients. Methods 3D imaging was used to assess chamber cavity size relative to the CFVAD. Additionally a novel 3D printed CFVAD model designed in SolidWorks (Waltham, MA) was printed with biocompatible material (Figure 1A) was used intraoperatively to assess fit. The model inflow was used to limit inflow projection as desired using Teflon washers (Figure 1B). The washers were telescoped on the model inflow with the sewing ring and fixed with four interrupted 3-0 prolene sutures to avoid malalignment, and ease the use of the coring device and CFVAD implantation. Results 3 patients (2-non compaction cardiomyopathy, 1-transplant graft dysfunction) underwent CFVAD implantation (2 LVAD and 1 BiVAD) using these techniques. Intrathoracic fit was obtained by incising the pleuropericardial folds, release of hemidiaphragm or remodeling of anterior chest wall (for RVAD). As predicted by the model, sternal closure could only be achieved after costal cartilage and rib segment resection in 1 patient who needed BiVAD. Postoperative VAD flows were satisfactory in all patients. Conclusion Combination of preoperative virtual fit assessment using 3D imaging and intraoperative fit using 3D printed model of VAD can be used to accurately determine fit of adult CFDs in pediatric patients. The 3D model is useful in tailoring the maneuvers needed to achieve uncomplicated intracardiac, intrapericardial and intrathoracic fit and sternal closure.