Patients with Surgical Corrected TGA or Congenital Corrected TGA Supported with Durable VAD

Abstract

Purpose We aimed to analyze durable VAD support of an anatomical right ventricle as systemic ventricle (any patients born with a transposition of the great arteries (TGA); either ccTGA or surgical corrected TGA using Mustard/Senning procedure). Methods Data retrieval from the EUROMACS registry (13th December 2017) with 3129 durable VAD implantations listed 68 patients with CHD. Sixteen patients (3♀,13♂), from 8 different centres, were identified to suffer from TGA (2 ccTGA, 14 dTGA). Results The study group had a median age of 33yrs. (range 2 - 74) compared to a median age of 51.6 yrs. (range 1 - 81) to the rest of the registry. The mean ejection fraction of the systemic ventricle was 20% ±3.6% at time of implantation. Most patients were in Intermacs stage 2 (range 1-4), two patients were on ECMO, one on IABP and 12 on inotropes prior to implantation. Two patients received a BiVAD (both dTGA)(Berlin Heart (1), HM II (1) whereas all others received a SVAD/LVAD (HM II (5), HVAD (9)). Intention to treat was transplantation (12), permanent support (2) and bridge to decision (2). Mean overall follow-up time was 513.5 ±366 days (range 20-1169). Seven patients were transplanted after a mean support time of 386 ±226.7 days. Three patients are still on support. Overall 38% of patients died (n:6) on support (median support time: 501 ±325 days). One year mortality was 12.5% (n:2). Conclusion Compared with the second annual EUROMACS report (2,681 pts.) where one year survival was reported with 66%, we found in this small cohort (16 pts.; 0.5% of the whole database) a one year survival of 87.5%. Of note is the significant younger age at implantation for this cohort compared to the rest of the EUROMACS registry Population.