Consultant Cardiac Surgeon, Freeman Hospital Newcastle upon Tyne, 2007-2015
Specialist Registrar Cardiac Surgery
Royal Brompton Hospital London UK
Birmingham Children’s Hospital Birmingham UK
LATEST ON ASSIST DEVICES AND TRANSPLANTATION
The usage of mechanical cardiac support (MCS) for bridging adult patients with heart failure to cardiac transplantation has massively increased in the last two decades. Concomitantly, there has also been an increased number of ACHD patients who required MCS. Amongst them, the vast majority is represented by patients with failing systemic right ventricle as in congenitally corrected transposition or after atrial switch procedures and patients with failing single ventricle circulation (Fontan). Whilst in failing systemic right ventricle the MCS in the form of ventricular assist device (VAD) has shown encouraging results, the implementation of MCS in failing Fontan circulation is often troublesome with suboptimal outcomes. Furthermore, cardiac transplantation in this subgroup of patients still carries a considerable risk when compared with other patients, particularly in the adult age. This is mostly due to presence of end organ damage, often sub-clinical, caused by long-standing venous hypertension, low cardiac output state and high pulmonary vascular resistance. However, improvements in the peri-operative strategies, surgical techniques, and post operative management including mechanical support have resulted in better outcomes than before, particularly in specialized centres.