Abstract
The development of durable ventricular assist devices (VADs) has improved mortality rates and quality of life in patients with end stage heart failure. While the use of VADs has increased dramatically in recent years, there is limited experience with VAD implantation in patients with complex congenital heart disease (CHD), despite the fact that the number of patients with end stage CHD has grown due to improvements in surgical and medical care. VAD use has been limited in patients with CHD and end stage heart failure due to anatomic (systemic right ventricle, single ventricle, surgically altered anatomy, valve dysfunction, etc.) and physiologic constraints (diastolic dysfunction). The total artificial heart (TAH), which has right and left sided pumps that can be arranged in a variety of orientations, can accommodate the anatomic variation present in CHD patients. This review provides an overview of the potential use of the TAH in patients with CHD.
Highlights
Ventricular assist devices (VADs) have been shown to improve mortality and quality of life in adults with refractory heart failure
This was demonstrated by Morales et al (2012) in a patient with corrected transposition of the great arteries (ccTGA) who presented with multi-system organ failure in the setting of severe biventricular dysfunction, severe aortic insufficiency and obstruction of a leftventricle to pulmonary artery conduit
The last few decades have seen a dramatic improvement in clinical outcomes among patients with congenital heart disease (CHD)
Summary
Ventricular assist devices (VADs) have been shown to improve mortality and quality of life in adults with refractory heart failure. Recent reports have shown a dramatic increase in VAD use in children as well (Almond et al, 2013; Villa et al, 2017) as ∼20% of pediatric patients are bridged to transplant with a VAD in the current era (Dipchand et al, 2014). These trends in VAD utilization have in turn driven improvements in waitlist mortality for both children (Zafar et al, 2015a) and adults (Emin et al, 2013). This review will discuss the physiology underlying end stage heart disease with a focus on the potential use of the total artificial heart (TAH)
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