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Ventricular assist devices for failing systemic right ventricle in adults with prior atrial switch procedure and congenitally corrected transposition of the great arteries:responders vs non responders

Session Poster Session 1

Speaker Oscar Gonzalez Fernandez

Event : ESC Congress 2018

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Congenital Heart Disease: Treatment, Other
  • Session type : Poster Session

Authors : O Gonzalez-Fernandez (Newcastle upon Tyne,GB), K Jansen (Newcastle upon Tyne,GB), G Macgowan (Newcastle upon Tyne,GB), A Woods (Newcastle upon Tyne,GB), N Robinson-Smith (Newcastle upon Tyne,GB), S Tovey (Newcastle upon Tyne,GB), A Hasan (Newcastle upon Tyne,GB), L Coats (Newcastle upon Tyne,GB), D Crossland (Newcastle upon Tyne,GB), J O'sullivan (Newcastle upon Tyne,GB), S Schueler (Newcastle upon Tyne,GB)

Authors:
O. Gonzalez-Fernandez1 , K. Jansen1 , G. MacGowan1 , A. Woods1 , N. Robinson-Smith1 , S. Tovey1 , A. Hasan1 , L. Coats1 , D. Crossland1 , J. O'Sullivan1 , S. Schueler1 , 1Freeman Hospital, Cardiothoracic - Newcastle upon Tyne - United Kingdom ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 109

Introduction: In patients post atrial switch procedure for transposition of the great arteries (TGA) and in those with congenitally corrected TGA (ccTGA), systemic right ventricular failure (SRVF) is an inevitable late complication. Ventricular assist devices (VAD) as a bridge to transplant and as strategy to reduce pulmonary vascular resistance have previously been proven successful in this group. The aim of this study was to analyse whether different echocardiographic or haemodynamic profiles are associated with mortality.

Methods: A retrospective review of all adult patients who received a Heartware-VAD for SVRF from 2010 to 2017 in a single-centre was performed. Clinical data and data from echocardiogram and right heart catheterisation performed before and 6 months after VAD implantation, or at latest follow up for those who died, were analysed.

Results: A total of 13 patients (mean age 36.3±5.7 years, 88.9% male) underwent VAD implantation for SRVF (12 post atrial switch and 1 with ccTGA). Four patients died at 65, 101, 229 and 387 days respectively. No statistically significant echocardiographic and haemodynamic differences were found pre-VAD implantation between patients alive and those who died. However, after VAD implantation, different profiles emerged (table 1). Amongst those alive, a significant reduction in the systemic ventricle end-diastolic dimension (EDD) was noted 6 months post VAD (p=0.04) and, although non-significant, a similar trend was seen for the subpulmonic ventricle EDD. Patients alive were also found to have a significant decrease in the transpulmonary gradient at 6 months post VAD (p=0.03), as well as a non-significant but similar trend in the pulmonary and right atrium pressures. In contrast, patients who died did not show a reduction in echocardiographic and haemodynamic parameters.

Conclusion: VAD implantation for SRVF is associated with good survival at 6 months. Baseline echocardiographic and haemodynamic parameters did not differ amongst survivors and non-survivors. But in contrast to those alive, there was no evidence of reverse remodelling post VAD in those who died.

Table 1. Echocardiographic-haemodynamic profiles
Alive (n=9) Pre-VADAlive (n=9) 6M post-VADp-valueDeath (n=4) Pre-VADDeath (n=4) 6M post-VAD or latest FUp-value
Subpulmonic EDD (cm)5.11±0.554.37±1.170.184.68±0.855.15±0.53NS
Systemic EDD (cm)6.2±1.155.46±0.710.045.37±0.465.03±0.88NS
RA (mmHg)12.5±5.768.89±4.040.2113.5±2.3819±0NS
MeanPA (mmHg)44.33±12.2130.89±11.080.0945±2.1648±0NS
PWP (mmHg)27.78±10.3320.22±7.260.1428.75±8.2229±1.41NS
TPG (mmHg)16.56±4.4510.67±4.870.0316.25±6.619±1.41NS

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