Improving Mechanical Circulatory Support Outcomes in Failing Bidirectional Glenn Physiology

There remains high morbidity and mortality with mechanical circulatory support (MCS) in failing bidirectional Glenn (BDG) physiology. We performed a retrospective analysis of children with BDG physiology supported with MCS before and after 2018. Fourteen patients met inclusion criteria (median age 1.5 years, weight 9 kg). Prior to 2018 (n = 7), with variable anticoagulation and strategies including pulsatile VAD, continuous flow VAD, and extracorporeal membrane oxygenation (ECMO), 3 (43%) of patients were transplanted with a total of 536 patient-days of support (median 59 days). Major hemocompatability-related adverse event (MHRAE) rate was 63 per 100 patient-months. After 2018 (n = 7), using a staged support strategy (ECMO to pulsatile VAD) and bivalirudin anticoagulation, 5 (71%) patients were transplanted with a total of 1260 patient-days of support (median 188 days) and MHRAE rate of 24 per 100 patient-months. Despite challenging physiology, we have observed improved survival and reduced MHRAE despite longer support duration.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Children with failing bidirectional Glenn physiology on MCS; the post-2018 strategy combining staged ECMO-to-pulsatile-VAD support with bivalirudin anticoagulation reduced major hemocompatibility adverse events from 63 to 24 per 100 patient-months despite longer support duration.

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