Mechanical circulatory support as a bridge to candidacy in adults with transposition of the great arteries and a systemic right ventricle

• Published in: European journal of cardio-thoracic surgery Vol. 59; no. 2; pp. 369 - 374
• Main Authors: Gyoten, Takayuki, Rojas, Sebastian V, Fox, Henrik, Schramm, René, Hakim-Meibodi, Kavous, Ruiz-Cano, Maria, Gummert, Jan F, Morshuis, Michiel, Sandica, Eugen
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 01.02.2021
• Subjects: Bridge to candidacy; Left ventricular assist device (LVAD); HVAD; HeartWare; Continuous flow Ventricular assist device; Transposition of the great arteries; Bridge to transplantation
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezaa373

Abstract OBJECTIVES Clinical experience with continuous flow ventricular assist devices (VADs) in patients with transposition of the great arteries (TGA) including dextro-TGA and congenitally corrected TGA is rare, and indications as well as potential benefits or specific hurdles remain unclear. Therefore, our goal was to report on our experience regarding VAD therapy in adult patients with TGA as a bridge to candidacy. METHODS We performed a single-centre retrospective study of all adult patients with TGA with systemic right ventricular failure who had continuous flow VAD implants between 2010 and 2018. Study end points were all causes of death, major cardiac and cerebrovascular adverse events or pump thrombosis. Follow-up continued until the time of the heart transplant. RESULTS A total of 6 patients (4 men) had a continuous flow VAD implanted in the context of a failing systemic right ventricle (dextro-TGA after the Mustard procedure: n = 3; congenitally corrected TGA: n = 3). Demographics: mean age 32 ± 5.7 years; median Interagency Registry for Mechanically Assisted Circulatory Support: level II (range 1–4), mean pulmonary artery 48 ± 13 mmHg, mean pulmonary vascular resistance 5.6 ± 3.5 Wood units. Postoperative data: intensive care unit stay: 16 ± 9.7 days; in-hospital survival: 100%; no early VAD-related complications occurred. Mean follow-up: 33 ± 18 months; persistent left-side paresis: n = 1; minor (non-disabling) stroke: n = 2. Post-VAD pulmonary artery: 19 ± 3.4 mmHg; P < 0.005; post-VAD pulmonary resistance: 2.2 ± 0.55 Wood units; P = 0.066. Four patients had heart transplants after a mean waiting time of 30 months after the VAD was implanted; 2 patients are still on the waiting list (waiting time: 52 and 24 months). CONCLUSIONS Continuous flow VAD therapy is a feasible therapeutic option in adult patients with TGA and a failing systemic right ventricle as a bridge to candidacy and a bridge to a heart transplant. The arterial switch operation has become the standard procedure for patients with simple transposition of the great vessels (dextro [d]-TGA); it restores the morphological left ventricle as a systemic ventricle.