Durable Ventricular Assist Device Support for Failing Systemic Morphologic Right Ventricle: Early Results Ed Peng, FRCS(CTh), John J. O’Sullivan, FRCP(UK),

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Presentation transcript:

Durable Ventricular Assist Device Support for Failing Systemic Morphologic Right Ventricle: Early Results Ed Peng, FRCS(CTh), John J. O’Sullivan, FRCP(UK), Massimo Griselli, FRCS(CTh), Chandrika Roysam, FRCA(UK), David Crossland, MRCP(UK), Milind Chaudhari, FRCPCH(UK), Neil Wrightson, BS, Tanveer Butt, FRCS, Gareth Parry, FRCP, Guy A. MacGowan, FRCPI, Stephan Schueler, PhD, Asif Hasan, FRCS(CTh) The Annals of Thoracic Surgery Volume 98, Issue 6, Pages 2122-2129 (December 2014) DOI: 10.1016/j.athoracsur.2014.06.054 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) A HeartWare Ventricular Assist Device (HVAD; HeartWare International Inc, Framingham, MA) was implanted in the right ventricle (RV) free wall of the systemic RV in a patient with Mustard procedure for transposition of the great arteries-intact septum. (B) The HVAD outflow cannula was anastomosed to the innominate artery in a patient where dense adhesion precluded connection to the ascending aorta. The Annals of Thoracic Surgery 2014 98, 2122-2129DOI: (10.1016/j.athoracsur.2014.06.054) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) A chest roentgenogram (patient A) after HeartWare (HeartWare International Inc, Framingham, MA) implantation for a patient with Mustard operation for transposition of the great arteries (TGA) with an intact septum. The device was inserted to the inferior surface of the rightward, systemic morphologic right ventricle (RV). (B) A chest roentgenogram after HeartWare implantation in patient C with congenitally corrected TGA. The device was inserted to the inferior surface of the leftward, systemic morphologic RV. The Annals of Thoracic Surgery 2014 98, 2122-2129DOI: (10.1016/j.athoracsur.2014.06.054) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Flowchart shows outcomes for the 7 patients overall and for the patients with bridge to transplantation (BTT) or bridge to decision (BTD) who were supported with the HeartWare Ventricular Assist Device (HVAD; HeartWare International Inc, Framingham, MA). (INTERMACS = Interagency Registry for Mechanically Assisted Circulatory Support; RV = right ventricle; TGA = transposition of the great arteries; VAD = ventricular assist device.) The Annals of Thoracic Surgery 2014 98, 2122-2129DOI: (10.1016/j.athoracsur.2014.06.054) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Graph shows transpulmonary gradient (TPG) in mm Hg before and after ventricular assist device (VAD) implantation. The 3 patients with the highest TPG pre-VAD were in the bridge-to-decision (BTD) group. The Annals of Thoracic Surgery 2014 98, 2122-2129DOI: (10.1016/j.athoracsur.2014.06.054) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Kaplan-Meier survival curves compare 22 patients on HeartWare Ventricular Assist Device (HeartWare International Inc, Framingham, MA) with dilated cardiomyopathy (DCM; blue line) and 7 patients with systemic right ventricular (RV) failure (green line; p = 0.38 by log-rank test). Patients were censored at transplant. The Annals of Thoracic Surgery 2014 98, 2122-2129DOI: (10.1016/j.athoracsur.2014.06.054) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions