Abstract |
Some neonates with functionally univentricular hearts are at extremely high risk for conventional surgical palliation. Primary cardiac transplantation offers the best option for survival of these challenging neonates; however, waitlist mortality must be minimized. We have developed a comprehensive strategy for the management of neonates with functionally univentricular hearts that includes the selective use of conventional neonatal palliation in standard-risk neonates, hybrid approaches in neonates with elevated risk secondary to a noncardiac etiology, and neonatal palliation combined with insertion of a single ventricular assist device (VAD) in neonates with elevated risk secondary to a cardiac etiology. Here we describe our selection criteria, technical details, management strategies, pitfalls, and current outcomes for neonates with functionally univentricular hearts supported with a VAD. Our experience shows that extremely high-risk neonates with functionally univentricular hearts who are poor candidates for conventional palliation can be successfully stabilized with concomitant palliation and pulsatile VAD insertion while awaiting cardiac transplantation.
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Authors | Mark S Bleiweis, James C Fudge, Giles J Peek, Himesh V Vyas, Susana Cruz Beltran, Andrew D Pitkin, Kevin J Sullivan, Jose F Hernandez-Rivera, Joseph Philip, Jeffrey P Jacobs |
Journal | JTCVS techniques
(JTCVS Tech)
Vol. 13
Pg. 194-204
(Jun 2022)
ISSN: 2666-2507 [Electronic] United States |
PMID | 35711213
(Publication Type: Editorial)
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Copyright | © 2021 The Author(s). |