Cardiac Transplantation After HYBRID+VAD Support in Patients with HLHS

L. R. Kugler¹, J. Jacobs¹, J. Phili[p¹, J. Fudge¹, J. Coppola¹, D. Gupta¹, B. Pietra¹, F. Fricker¹, M. S. Purlee¹, A. Bilgili², Y. Stukov¹, G. Peek¹, M. Bleiweis^1
1University of Florida, Gainesville, Florida ²The University of Florida College of Medicine, Jacksonville, Florida

Purpose: High risk patients with HLHS can be supported with a HYBRID+VAD approach as bridge to cardiac transplantation. Concerns have been raised about the challenges and complexity of the subsequent cardiac transplant. The purpose of this analysis is to review our experience with 7 consecutive infants undergoing cardiac transplantation after HYBRID+VAD.

Methods: A total of 7 high-risk neonates (Table 1) with major cardiac risk factors and HLHS or HLHS-related malformation with functionally univentricular ductal dependent systemic circulation underwent cardiac transplantation after initial palliation with HYBRID+VAD (VAD insertion, stenting of the arterial duct, placement of bilateral pulmonary arteries bands, and atrial septectomy if needed), as shown in Figure 1. We retrospectively reviewed the pre-operative, intraoperative, and postoperative course of the cardiac transplant of these 7 patients. Data are reported as N (%) and median (range).

Results: Table 1 provides preoperative, interoperative, and postoperative data about 7 infants transplants after support with HYBRID+VAD.

Of these 7 patients successfully bridged to transplant, most were male: n=5 (71.4%), and white: n=6 (85.7%). The median length of VAD support was 154 days (64-226 days), and the median age at transplant was 177 days (84-250 days).

All seven patients successfully underwent OHT; six of these seven transplants (85.7%) were ABO incompatible (ABOi) transplants.

Intraoperative variables are presented below as median (range):
• median cardiopulmonary bypass time: 169 (139-208)
• median cross-clamp time (minutes): 89 (56-116)
• median antegrade cerebral perfusion time (minutes): 29 (24-39)
• median donor ischemic time (minutes): 212 (139-236)
• median minimum temperature: 20.4C (19.6C-22.8C).

Zero patients underwent surgical patch augmentation of the banded pulmonary arteries at the time of transplant, and all patients simply had PA band removal and dilation.

One patient had post-transplant vocal cord dysfunction and underwent g-tube insertion. No other patients had post-transplant complications.

Median post-transplant length of stay was 26 days (range=8-43 days). No patients have had further intervention of their aorta or pulmonary arteries.

All 7 patients are currently alive and well a median of 4.4 years (range=1.7-6.6 years) after cardiac transplantation.

Conclusion: High-risk neonates with major cardiac risk factors and HLHS can be safely supported with HYBRD+VAD while awaiting transplantation. Cardiac transplantation after support with a HYBRID+VAD approach can be performed safely and effectively and results in satisfactory short-term and mid-term survival. Additional longitudinal follow-up will help assess late outcomes.

Identify the source of the funding for this research project: None