First-in-Human Closed-Chest Transcatheter Superior Cavopulmonary Anastomosis

Kanishka Ratnayaka; John W Moore; Rodrigo Rios; Robert J Lederman; Sanjeet R Hegde; Howaida G El-Said

doi:10.1016/j.jacc.2017.06.020

First-in-Human Closed-Chest Transcatheter Superior Cavopulmonary Anastomosis

J Am Coll Cardiol. 2017 Aug 8;70(6):745-752. doi: 10.1016/j.jacc.2017.06.020.

Authors

Kanishka Ratnayaka¹, John W Moore², Rodrigo Rios², Robert J Lederman³, Sanjeet R Hegde², Howaida G El-Said²

Affiliations

¹ Division of Cardiology, Rady Children's Hospital, Department of Pediatrics, University of California San Diego, San Diego, California; Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland. Electronic address: kratnayaka@rchsd.org.
² Division of Cardiology, Rady Children's Hospital, Department of Pediatrics, University of California San Diego, San Diego, California.
³ Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.

Abstract

Background: In the care of patients with congenital heart disease, percutaneous interventional treatments have supplanted many surgical approaches for simple lesions, such as atrial septal defect. By contrast, complex congenital heart defects continue to require open-heart surgery. In single-ventricle patients, a staged approach is employed, which requires multiple open-heart surgeries and significant attendant morbidity and mortality. A nonsurgical transcatheter alternative would be attractive.

Objectives: The authors sought to show the feasibility of catheter-only, closed-chest, large-vessel anastomosis (superior vena cava and pulmonary artery [PA] or bidirectional Glenn operation equivalent) in a patient.

Methods: In preclinical testing over a decade, the authors developed the techniques and technology needed for nonsurgical crossing from a donor (superior vena cava) to a recipient (PA) vessel and endovascular stent-based anastomosis of those blood vessels. The authors undertook this transcatheter approach for an adult with untreated congenital heart disease with severe cyanosis and significant surgical risk. They rehearsed the procedure step by step using contrast-enhanced cardiac computed tomography and a patient-specific 3-dimensional printed heart model.

Results: The authors describe a first-in-human, fully percutaneous superior cavopulmonary anastomosis (bidirectional Glenn operation equivalent). The patient, a 35-year-old woman, was homebound due to dyspnea and worsening cyanosis. She was diagnosed with functional single ventricle and very limited pulmonary blood flow. The heart team believed surgical palliation conferred high operative risk due to the patient's complete condition. With the percutaneous procedure, the patient recovered uneventfully and remained improved clinically after 6 months.

Conclusions: This procedure may provide a viable alternative to one of the foundational open-heart surgeries currently performed to treat single-ventricle congenital heart disease.

Keywords: Glenn shunt; adult congenital heart disease; catheterization; image-guided intervention; single ventricle; transcatheter electrosurgery.

Publication types

Case Reports

MeSH terms

Adult
Cardiac Catheterization / methods*
Cardiac Surgical Procedures / methods*
Feasibility Studies
Female
Heart Bypass, Right / methods*
Heart Defects, Congenital / diagnosis
Heart Defects, Congenital / surgery*
Heart Ventricles / surgery*
Humans
Imaging, Three-Dimensional
Pulmonary Artery / surgery*
Tomography, X-Ray Computed
Vena Cava, Superior / surgery*

Grants and funding

ZIA HL006040-07/Intramural NIH HHS/United States