Long-term continuous flow ventricular assist in children and adult congenital patients (HeartWare and HeartMate): Current status in France and feedback

Abstract

The ACHD patient population has the highest rate of death on the transplant waiting list. Compared to optimal medical therapy, continuous flow LVADs (HeartMate and HeartWare) improve survival, quality of life, allow patients to return home. Among them, the HeartMate 3 (HM3) device has the fewest reported adverse events, and the only one available since 2021. HM3 use is associated with low mortality and few adverse events. Foreign literature reports implantations in children as small as 19 kg, as well as ACHD patients with complex heart disease. Current data on the efficacy and safety of implantation in these patients are favorable. No cases have been reported in France to date. To determine the current state of practice in France regarding long-term continuous left-sided single ventricular assist in children and adult congenital patients. To present the results of two successful French implantations. Between June and July 2022, the different pediatric and adult congenital cardiac surgery centers in France and the manufacturers Abbott (HeartMate) and Medtronic (HeartWare) were contacted. A questionnaire will be sent to surgical centers to understand the low use of this type of assistance in France in 2022. The cases of two patients implanted at the Georges Pompidou European Hospital between 2020 and 2022 will be reported: the case of a 15-year-old patient with dilated cardiomyopathy in the context of Duchenne muscular dystrophy, and the case of a 36-year-old patient with Fontan circulation and systolic dysfunction of his single ventricle. The description will include quality of life indexes, collected by means of a questionnaire under stable conditions. The aim of this study is to identify the reasons for the low use of long-term continuous left single ventricular assistance in the population concerned. The aim will be to promote this practice in this population. The sharing of experiences is essential in such a specialized field. We will propose lines of thought to promote long-term assistance in non-experienced centers.