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Canadian Journal of Cardiology

Ventricular Assist Device Use in Patients With Single-Ventricle Circulation

Published:March 18, 2022DOI:https://doi.org/10.1016/j.cjca.2022.03.012

      Abstract

      Ventricular assist devices (VADs) are being increasingly used to support patients with congenital heart disease and single-ventricle physiology. Because of their unique anatomy and physiology, special consideration must be used to provide effective mechanical circulatory support for each individual patient. This can include alternative cannulation techniques, strategies to balance cardiac output to the systemic and pulmonary circulations from a single ventricle, or the use of continuous vs pulsatile VADs for better ventricular offloading. In this article we review the etiology of single-ventricle failure, VAD options for support, cannulation strategies, post-VAD management considerations, and outcomes at each of the 3 stages of palliation.

      Résumé

      Les dispositifs d’assistance ventriculaire (DAV) sont de plus en plus utilisés chez les patients présentant une cardiopathie congénitale et un cœur univentriculaire. Or, chacun de ces patients présente des caractéristiques anatomiques et physiologiques uniques auxquelles il convient d’être particulièrement attentif si l’on veut mettre en place une assistance circulatoire mécanique efficace, laquelle peut prendre diverses formes : techniques de canulation non conventionnelles, stratégies d’équilibrage des débits systémique et pulmonaire de la circulation univentriculaire ou mise en place de DAV à flux continu ou pulsatile permettant une meilleure décharge ventriculaire. Dans le présent article, nous passons en revue l’étiologie de l’insuffisance cardiaque univentriculaire, les options en matière de DAV, les stratégies de canulation, les modalités de prise en charge des porteurs de DAV et l’issue de chacune des trois étapes de palliation.
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