Ventricular Assist Devices in Adults With Transposition of the Great Arteries and Systemic Right Ventricle: Systematic Literature Review.

Background

In adult patients with transposition of the great arteries (TGA) and systemic right ventricle (sRV), the use of ventricular assist devices (VADs) is uncommon.

Methods

We conducted a systematic review of published studies to examine the indications, hemodynamic effects, and outcomes of VADs in this patient population. We reviewed English-language literature for case reports, case series, and reviews that included individual patient data, such as demographics, hemodynamic parameters, types of implanted VADs, and outcomes.

Results

We identified 107 patients, 76% (81/107) males, mean age 40.2 ± 10.6 at the time of implantation, 38.3% (41/107) with left TGA (L-TGA), and 61.7% (66/107) with dextro-TGA (D-TGA). The VAD support resulted in hemodynamic improvement, including a decrease in the mean pulmonary arterial pressure (45 ± 15 mm Hg before implantation to 25 ± 9.3 mm Hg afterwards, P < .001), pulmonary vascular resistance (6.3 ± 4.9 Wood units (WU) to 2.4 ± 1.35 WU, P < .001), right atrial pressure (16.4 ± 7.3 mm Hg to 9.5 ± 3.7 mm Hg, P = .009), and pulmonary capillary wedge pressure (25.45 ± 7.12 mm Hg to 14.25 ± 5.6 mm Hg, P < .001). The cardiac index increased from 2.0 ± 0.5 L/min/m² to 2.8 ± 0.6 L/min/m² (P = .004). The 1-year survival rate was 80.5%. Eventually, 31 (29%) underwent heart transplantation, and 48 (54%) remained on VAD at the time of publication.

Conclusions

Durable VADs provide hemodynamic improvement and excellent survival in adults with a systemic right ventricle. Expanding the use of VADs for this patient population would be justified.