Browse by author
Lookup NU author(s): Fabrizio De Rita, Dr Louise CoatsORCiD, Dr David Crossland, Mohamed Nassar, Dr Tony Hermuzi, Dr Neil Seller, Dr Adam McDiarmid, Dr Stephan Schueler, Dr Guy MacGowanORCiD, Dr Katrijn Jansen
Full text for this publication is not currently held within this repository. Alternative links are provided below where available.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. OBJECTIVES: Ventricular assist device (VAD) for systemic right ventricular (RV) failure patients post-atrial switch, for transposition of the great arteries (TGA), and those with congenitally corrected TGA has proven useful to reduce transpulmonary gradient and bridge-to-transplantation. The purpose of this study is to describe our experience of VAD in systemic RV failure and our move towards concomitant tricuspid valve replacement (TVR). METHODS: This is a single-centre retrospective study of consecutive adult patients receiving HeartWare VAD for systemic RV failure between 2010 and 2019. From 2017, concomitant TVR was performed routinely. Demographic, clinical variables and echocardiographic and haemodynamic measurements pre- and post-VAD implantation were recorded. Complications on support, heart transplantation and survival rates were described. RESULTS: Eighteen patients underwent VAD implantation. Moderate or severe systemic tricuspid regurgitation was present in 83.3% of patients, and subpulmonic left ventricular impairment in 88.9%. One-year survival was 72.2%. VAD implantation was technically feasible and successful in all but one. Post-VAD, transpulmonary gradient fell from 16 (15-22) to 10 (7-13) mmHg (P = 0.01). Patients with TVR (n = 6) also demonstrated a reduction in mean pulmonary and wedge pressures. Furthermore, subpulmonic left ventricular end-diastolic dimension (44.3 vs 39.6 mm; P = 0.03) and function improved in this group. After 1 year of support, 72.2% of patients were suitable for transplantation. CONCLUSIONS: VAD is an effective strategy as bridge-to-candidacy and bridge-to-transplantation in patients with end-stage systemic RV failure. Concomitant TVR at the time of implant is associated with better early haemodynamic and echocardiographic results post-VAD.
Author(s): Gonzalez-Fernandez O, De Rita F, Coats L, Crossland D, Nassar MS, Hermuzi A, Santos Lopes B, Woods A, Robinson-Smith N, Petit T, Seller N, O'Sullivan J, McDiarmid A, Schueler S, Hasan A, MacGowan G, Jansen K
Publication type: Article
Publication status: Published
Journal: European Journal of Cardio-Thoracic Surgery
Year: 2022
Volume: 62
Issue: 3
Print publication date: 01/09/2022
Online publication date: 04/03/2022
Acceptance date: 23/02/2022
ISSN (print): 1010-7940
ISSN (electronic): 1873-734X
Publisher: Oxford University Press
URL: https://doi.org/10.1093/ejcts/ezac130
DOI: 10.1093/ejcts/ezac130
PubMed id: 35244691
Altmetrics provided by Altmetric
