Abstract 18136: Mechanical Circulatory Support for Failing Systemic Right Ventricle - A Viable Bridging Strategy to Transplant?

Abstract

BACKGROUND: The morphological right ventricle in the systemic position is associated with late failure and cardiac transplantation becomes the only treatment option. In the face of declining heart donor, the role of left ventricular assist device (VAD) as a bridge to transplant is well established. However, there is only scarce experience of supporting failing systemic right ventricle (RV). METHODS: Between 1989 and 2013, a total of 21 adult patients (age 18 years and above) had heart transplant in our institution for systemic RV failure. Since our inception case to support failing systemic RV mechanically in 2009, a total of six adult patients (5 males, mean age 36 years; 4 post atrial switch, 2 ccTGA) had been supported (5 Heartware and 1 Berlin Heart). Concomitant systemic atrioventricular surgery was required in two patients. Indications for systemic RV-VAD were (i) bridge to transplant (n=2) (group BTT) and (ii) bridge to further decision in the presence of high transpulmonary gradient and/or high PRA (n=4) (group BTD). RESULTS: Early mortality (< 30 days) was 16.7% (n=1). One further patient died in-hospital following non-cardiac procedure (day 62). Overall, median ICU stay was 6 days (range 5-8 days). Four patients were discharged home: three patients reported significant improvement in functional capacity and serial TPGs assessment showed significant improvement. In group BTT, 1 was transplanted (at day 313 post-VAD). In group BTD, 1 patient was transplanted (day 685), one has on-going support (currently 375 days), and one died (day 232, sepsis and multi-organ failure). Three patients (50%) had cerebrovascular events (3, 4, 15 months post-VAD) with satisfactory recovery and one had recurrent bleeding episodes. One patient required further surgery (aortic valve replacement and device replacement due to thrombosis). Survival at transplant was 100% for those with VAD (n=2) (vs 89.5% for those without VAD support, n=17/19). CONCLUSION: The use of ventricular assist device to support failing systemic RV is a viable strategy to bridge for transplant or further assessment. Neurological event, albeit with satisfactory recovery, remains a significant morbidity.