Thorac Cardiovasc Surg 2015; 63 - OP131
DOI: 10.1055/s-0035-1544383

Creation of a Venous Reservoir for RVAD Implantation in Failing Fontan - Prêtre Modification

S. Sandrio 1, A. Purbojo 1, A. Rüffer 1, S. Dittrich 2, R. Cesnjevar 1
  • 1Friedrich-Alexander-University Erlangen-Nuremberg, Kinderherzchirurgie, Erlangen, Germany
  • 2Friedrich-Alexander-University Erlangen-Nuremberg, Kinderkardiologie, Erlangen, Germany

Objective: This video shows the surgical creation of a venous reservoir for RVAD implantation in a GUCH patient with failing Fontan circulation.

Method and Result: A 23 year old patient had undergone a BT-shunt followed by AP-shunt, BDG and TCPC for palliation of pulmonary valve atresia and intact ventricular septum. Over time, she developed persistent, drug resistant severe protein losing enteropathy (PLE) and ascites. Multiple treatment options have been tried, but she continued to have watery diarrhea with a daily stool volume up to 5L. Despite being on the waiting list for years, no transplantation was possible due to donor organ shortage. Due to normal LV function and mitral valve, RVAD implantation was opted for long-term support, either as chronic palliation with a mobile device or as bridge-to-transplantation. Surgery was performed through a median sternotomy using CPB. As described by Prêtre et al. a venous reservoir was created, using a 30 mm Dacron graft. After BDG takedown, PA was reconstructed with bovine pericardial patch and SVC was anastomosed with the cranial end of the venous reservoir. Bovine pericardial patch was used to augment the SVC connection to the reservoir. IVC was sutured to the caudal end of the graft after division of the extracardiac TCPC conduit. The anterior reservoir side was anastomosed with the inflow cannula of Berlin Heart extracorporeal VAD with an additional Dacron patch to augment the anterior part of the reservoir. The outflow cannula was connected to the cranial end of the divided TCPC conduit. The intra- and postoperative course was unproblematic and patient was extubated on 1st postoperative day.

Conclusion: Chronic low cardiac output in Fontan circulation is mainly caused from reduced preload of the single ventricle. Elevated venous and lymphatic pressures predispose Fontan patient to PLE and ascites. RVAD might solve these issues, decreasing venous and lymphatic pressures while increasing systemic ventricular preload.

Fig. 1 RVAD in failing Fontan.