Abstract
Mechanical circulatory support (MCS) for failing single ventricle (SV) physiology is a complex and challenging problem, which has not yet been satisfactorily addressed. Advancements in surgical strategies and techniques along with intensive care management have substantially improved the outcomes of neonatal palliation for SV physiology, particularly for hypoplastic left heart syndrome (HLHS). This is associated with a steady increase in the number of SV patients who are susceptible to develop heart failure (HF) and would potentially require MCS at a certain stage in their palliation. We have reviewed the literature regarding the reported modalities of MCS use in the management of SV patients. This includes analysis of various devices and strategies used for failing circulation at distinct stages of the SV pathway: after neonatal palliation, after the superior cavo-pulmonary connection (SCPC), and after total cavo-pulmonary connection (TCPC).
Highlights
Fontan and Baudet introduced the concept of single ventricle (SV) palliation in 1968, in a patient diagnosed with tricuspid atresia, by total right heart bypass achieved with atrio-pulmonary connection [1]
Given the shortage of cardiac allografts, it is obvious that cardiac transplantation alone is not a sustainable solution to address the epidemic of heart failure (HF) associated with SV physiology
Pearce et al reported a case of a child supported with Berlin Heart Excor (BHE) as a univentricular assist device (UVAD) after pulmonary artery banding followed by a modified Blalock-Taussig shunt (mBTs) for neonatal SV palliation, who was successfully transplanted [29]
Summary
Massimo Griselli 1*, Raina Sinha 1, Subin Jang 1, Gianluigi Perri 2 and Iki Adachi 3. Advancements in surgical strategies and techniques along with intensive care management have substantially improved the outcomes of neonatal palliation for SV physiology, for hypoplastic left heart syndrome (HLHS). This is associated with a steady increase in the number of SV patients who are susceptible to develop heart failure (HF) and would potentially require MCS at a certain stage in their palliation. We have reviewed the literature regarding the reported modalities of MCS use in the management of SV patients This includes analysis of various devices and strategies used for failing circulation at distinct stages of the SV pathway: after neonatal palliation, after the superior cavo-pulmonary connection (SCPC), and after total cavo-pulmonary connection (TCPC)
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