An Extended Role of Continuous Flow Device in Pediatric Mechanical Circulatory Support Ed Peng, FRCS(CTh), Richard Kirk, FRCP, Neil Wrightson, BS, Phuoc.

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Presentation transcript:

An Extended Role of Continuous Flow Device in Pediatric Mechanical Circulatory Support Ed Peng, FRCS(CTh), Richard Kirk, FRCP, Neil Wrightson, BS, Phuoc Duong, MRCPCH, Lee Ferguson, FRCA, Massimo Griselli, FRCS(CTh), Tanveer Butt, FRCS, John J. O’Sullivan, FRCP(UK), Guy A. MacGowan, FRCPI, David Crossland, MRCP, Stephan Schueler, PhD, Asif Hasan, FRCS(CTh) The Annals of Thoracic Surgery Volume 102, Issue 2, Pages 620-627 (August 2016) DOI: 10.1016/j.athoracsur.2016.02.013 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) The length of apical cannula without sewing ring is 3.0 cm (x) and with sewing ring, 2.5 cm (y). (B) Preoperative echocardiogram for a 3.7-year-old child (weight 13.5 kg). The dimension was 4.4 cm from the tip of the anterior mitral leaflet at maximal opening and 3.4 cm at mid cavity. With the left ventricle apical wall thickness measuring 0.9 cm, the effective length of the apical cannula in the left ventricle cavity would be 1.6 cm, and unobstructed inflow was anticipated. The Annals of Thoracic Surgery 2016 102, 620-627DOI: (10.1016/j.athoracsur.2016.02.013) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) An intraoperative “dummy” was used to assess whether the device would fit into the (B) left ventricle cavity and the mediastinum. (C, D) The device inflow was implanted at the inferior (diaphragmatic surface) of the left ventricle as shown on computed tomography images. The Annals of Thoracic Surgery 2016 102, 620-627DOI: (10.1016/j.athoracsur.2016.02.013) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) For patients who needed right ventricular assist device support, a vascular graft was anastomosed to the main pulmonary artery and exteriorized to the chest wall. (B) The inflow cannula was inserted percutaneously through the right internal jugular vein into the superior vena cava. These cannulas were connected to the short-term device Levitronix. The Annals of Thoracic Surgery 2016 102, 620-627DOI: (10.1016/j.athoracsur.2016.02.013) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The course of outcome after ventricular assist device implantation in patients with (A) biventricular assist device (BIVAD [n = 5]) and (B) left ventricular assist device (LVAD [n = 7]) implanted during the index operation. (RVAD = right ventricular assist device.) The Annals of Thoracic Surgery 2016 102, 620-627DOI: (10.1016/j.athoracsur.2016.02.013) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Right ventricle (RV) function assessment before HeartWare ventricular assist device (HVAD) and the outcome after HVAD implantation. (BIVAD = biventricular assist device; LVAD = left ventricular assist device; Tx = transplant.) The Annals of Thoracic Surgery 2016 102, 620-627DOI: (10.1016/j.athoracsur.2016.02.013) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions