A novel intracorporeal right ventricular assist device implantation technique in a young patient

Background Continuous-flow ventricular assist devices (CF VADs) designed for adults are increasingly used in pediatric patients. However, due to size and anatomy, there is greater risk of device inflow obstruction. Methods We reviewed all cases of systemic atrioventricular valve (AVV) excision with HeartWare VAD implantation in the systemic ventricle performed at our institution from November 2015 - May 2016. Results AVV excision with CF VAD implantation was undertaken in three patients. Patient 1 was palliated in infancy, resulting in biventricular physiology with a systemic right ventricle and presented at age 15 years with worsening ventricular dysfunction. After CF VAD implantation in the systemic ventricle and discharge to home, the patient developed tricuspid valve obstruction to VAD inflow and underwent TV excision on postoperative day 52. Patients 2 and 3 were under age 4 years with BSA 0.62 and 0.58 m 2 respectively, status-post Fontan palliation, with subsequent systemic ventricular dysfunction and AVV regurgitation. In both Fontan patients, the CF VAD was implanted in the right atrium with simultaneous excision of AVV. None have had evidence of elevated atrial pressures or recalcitrant pulmonary edema. At a mean follow-up of 359 days (range 304-422 days), there have been no concerns for inflow obstruction or low flow. Conclusions CF VAD implantation with AVV excision can successfully support complex pediatric patients in a wide range of size and anatomy (small chambers, systemic right ventricles). This technique may allow for CF VAD implantation in patients previously deemed too small for such support.