Evolving Understanding Of Total Artificial Heart Support Of Young Infants And Children
Ronald K. Woods, Robert Niebler, Micheal Mitchell, Viktor Hraska, Steve Kindel.
Medical College Wisconsin, Milwaukee, WI
Objective(s): To discern important lessons learned in our preliminary experience of total artificial heart (TAH) support of infants and children less than 10 kg.
Methods: Retrospective chart review of 5 consecutive patients with TAH support.
Results: In the past 1.5 years, we have provide TAH support to 5 children less than 10 kg. Four were salvage cases with prolonged ECLS support; 3 had open chests for more than 2 weeks; two were single-ventricle. In all cases, after resection of the ventricular mass, we utilized EXCOR cannulas with atrial septation for single ventricle patients. In 3 patients, we used EXCOR pumps and porcine valved inflow conduits to prevent left atrial hypertension. In 2, we used ringed PTFE for inflow conduits and centrifugal pumps. Support was good in all cases. Car was withdrawn in 2 cases for failure to improve. In 3, duration of support was 2-4 months - 2 are alive and well after transplant, 1 remains on support and doing well. Leaflets of the explanted valved conduits were thin and mobile. For pulsatile pumps, full fill cycles occurred despite using oversized pumps.
Conclusions: TAH support of young infants is feasible and can be modified for single ventricle patients. It permits early chest closure in even in the smallest patients. In a TAH arrangement, we need to learn more about pump sizing and the potential role of valved inflow conduits.