Comment
ESHF in patient with CHD who survive into adulthood remains today a challenge for both HT and VAD implantation, because of the complex pathophysiology and potential comorbidities.
To date, publications regarding outcomes and use of LVADs in ACHD patients are limited.
Of the 16,182 adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database, only 126 (0.8%) have CHD.1 Additional analysis on outcomes shows that ACHD patients with LVADs have similar survival, adverse event rates and similar improvements in functional capacity and quality of life compared with non-ACHD patients.6 Actually, INTERMACS registry 1 shows an overall-survival about 70% at 24 months after implantation of LVADs in ACHD patients, but no data are available on survival beyond 24 post-operative months.
Other literature data on VAD-surgery in ACHD patients consist mainly of case-reports or small series. Of note, besides our patient who reported the first implant ever of a HeartMate II in SVIT2, other HeartMate II implantations in adults with SVIT are only reported twice: Ariyachaipanich et al.3 described a case of right ventricular support with HeartMate II in a 56-year-old man with a history of SVIT as destination therapy (DT). The patient had an uncomplicated postoperative course and did not require any readmission during the first year after surgery. No data were available beyond the first postoperative year. Menachem et al.4 reported a case of a 75-year-old female with SVIT implanted with HeartMate II as DT. She expired early because of neurologic complications.
To the best of our knowledge therefore, this is the first documented case of 10-year survival after HeartMate II implantation in a patient with SVIT. Interestingly enough, long-term follow-up was quite uneventful for more than 8 years, and no device failure, pump thrombosis, or stroke occurred ever during ten-year follow-up, allowing an overall excellent quality of life for a decade. Of note, the prolonged withdrawal of both anti-platelet and anti-thrombotic regimens during the last haemorrhagic event did not led to VAD thrombosis or device malfunction, nor to thromboembolic events, possibly in light of a long-lasting complete formation of neo-intimal tissue with endothelialization of the inner surfaces of the device.
In conclusion, ESHF remains nowadays the leading cause of death for ACHD patients. The ease availability of LVADs provides an elegant solution to these complex scenarios, sometimes allowing long-lasting and consistent results as in the case reported. The recent availability of new generations of these devices can possibly raise the rod further in the next future.