Novel Trans-Septal Left Atrial VAD Cannulation Technique for Hypertrophic/Restrictive Cardiomyopathy

Abstract

Purpose Left ventricular assist device (LVAD) outcomes for hypertrophic (HCM) or restrictive cardiomyopathy (RCM) with a small LV are unsatisfactory due to difficulty draining via an LV apical cannula. We developed a new transeptal cannulation technique to decompress the left atrium where the atrial septum is cannulated via the right atrium. Methods Retrospective review of our institutional experience with LVAD/BiVAD implantation in HCM or RCM patients from October 2016 to Aug 2018. Outcomes following implantation were analyzed, including subsequent interventions, quality of VAD output, and patient outcomes. Results In total, 5 patients underwent LVAD implantation with trans-septal left-atrial cannulation techniques (HCM = 4 patients, RCM =1). Two patients received Berlin Heart BiVADs, 1 received a Berlin Heart LVAD, 1 patient received PediMag BiVADs, and 1 patient received a Heartware LVAD. Total support days were 485 days. Three patients underwent successful heart transplant after 275, 111 and 62 days of support. One neonate with HCM died from sepsis 27 days after PediMag BiVAD placement. One RCM patient died 10 days after Berlin Heart BiVAD placement following extracorporeal membrane oxygenation due to ARDS. Total survival rate is 60%. All three survivors did not develop any neurological deficits or complications related to thrombus and were discharged home after heart transplant. Conclusion This novel trans-septal left-atrial LVAD cannulation strategy is a viable alternative cannulation technique for HCM or RCM patients with a small left ventricular cavity. This technique can be applied to a variety of pediatric and adult devices in children ranging from infants to adults.