Left-Ventricular Assist Device (LVAD) and Aortopulmonary Shunt Creation to Support the Failing Univentricular Heart

Objectives: We report on a 15-year-old patient with failing single ventricle palliation admitted for cardiac transplantation for failing univentricular palliation after tricuspid atresia Ib. So far, a modified Blalock-Taussig shunt and a Glenn anastomosis were performed. Invasive evaluation revealed elevated pulmonary pressure, small pulmonary arteries and extensive pulmonaryarteriovenous fistulas (PAVM) formation in the left lung. Overall, the patient was considered non-transplantable. An alternative treatment strategy with implantation of a Heartware® ventricular assist device together with placement of a systemic shunt to the left lung to promote (1) regression of PAVM by re-establishing hepatic flow to the lung and (2) growth of the pulmonary vasculature, was developed.

Methods: A Heartware® HVAD ventricular assist device was implanted in the morphological left ventricle. Additionally, a subtotal separation of right- and left-pulmonary artery was created by narrowing of the pulmonary artery bifurcation, leaving the right lung to the Glenn circulation and the left lung to perfusion through the 6 mm aortopulmonary shunt.

Results: The patient was extubated on the first postoperative day and recovered uneventfully. The pump was set at 3000 rpḿs providing the patient with 6.5 to 7 L of additional cardiac output. Saturation increased from 30–40% before the procedure to 65–75% thereafter.

Conclusion: In failing single ventricle palliations, ventricular support by a Heartware® HVAD together with implantation of an aortopulmonary shunt and pulmonary artery separation ameliorates heart failure and cyanosis. This concept serves as a bridge to heart transplant or destination therapy in end stage univentricular CHD.