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

Abstract

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.