NEONATAL MECHANICAL BRIDGING TO TOTAL ORTHOTOPIC HEART-TRANSPLANTATION

Background. Until recently, newborns with medically intractable cardia c failure caused by congenital malformations were mostly doomed to dea th because of the severity of the disease, which precludes a palliativ e operation, or because of fatal deterioration before availability of a suitable donor heart. Methods. The recently developed paracorporeal pneumatically driven Medos HIA ventricular assist device offers a ther apeutic option for these small infants because it is manufactured in v arious sizes and is even suitable for cardiac assistance in neonates w ith a body surface area less than 0.3 m(2). Results. We report our ini tial experience with this device, which we used for univentricular bri dging to total orthotopic cardiac transplantation in 3 infants. The de vice was inserted to support the left ventricle in two instances and t o support the right heart in one. Successful bridging to transplantati on was achieved in 2 infants for periods of 2 and 7 weeks. Conclusions . Our experience demonstrates the feasibility of univentricular mechan ical support followed by successful cardiac transplantation in infants and newborns. (C)1998 by The Society of Thoracic Surgeons.