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Implantation of a HeartMate 3 Left Ventricular Assist Device in a Patient with Congenitally Corrected Transposition of the Great Arteries

https://doi.org/10.1016/j.healun.2019.01.941Get rights and content

Purpose

Congenitally corrected transposition of the great arteries (ccTGA) is a rare cause for heart failure. However, current VADs as the Heart Mate 3 have been designed and approved for left ventricular support. Their implantation in a right ventricle functioning as systemic ventricle may be challenging. We here present a case of a HeartMate 3 implantation in a patient with ccTGA and show the surgical and pathophysiological challenges.

Methods

We prospectively followed a patient with ccTGA.

Results

A 62 year old female patient with ccTGA and dextrocardia with situs solitus and decompensated heart failure (NYHA IV). She suffered from myocardial infarction with cardiogenic shock and recurrent ventricular fibrillation. Her clinical condition declined so that inotropic therapy was necessary. Echocardiography showed severe dysfunction of the systemic ventricle with severe systemic and subpulmonic atrioventricular valve regurgitation and poor pulmonic ventricle function Coronary angiogram showed one common ostium for all three vessels originating from the right coronary sinus and presented good result after PCI. Despite inotropic support the patient presented in INTERMACS 2 and waiting for heart transplantation was no option. A HeartMate 3 ventricular assist device (Abbott, Chicago, IL) was implanted through a full stertnotomy as a bridge to transplantation with concomitant subpulmonic atrioventricular valve reconstruction (Cosgrove-Edwards Band, 30mm). The morphological right ventricle was significantly trabeculated with a moderator band. The placement of the inflow cannula in the morphological RV was performed under echocardiographic guidance. Due to septal hypermobility with consecutive suction events a surgical revision was performed on the same day with fixing the pump to the diaphragm. The further postoperative course was uneventful and the patient was successfully discharged. Two years follow up showed normal LVAD function and no valve insufficiencies. There were no hospitalisations needed in the past 2 years.

Conclusion

We demonstrate the feasibility of the use of a HeartMate 3 in patients with congenital heart disease and its use as a bridge to heart transplantation in patients with ccTGA. Accurate determination of the best cannulation site using intraoperative echocardiographic guidance is recommended.

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