Redesigning Surgical Implantation Methods of Ventricular Assist Devices to Accommodate Patients with Congenital Heart Disease and Complex Anatomy

Gwendolyn Derk is a graduate student in the Kinesiology & Community Health Department at UIUC that collaborates with investigators at UCLA to develop new implantation methods for ventricular assist devices. This photo was taken by Ms. Derk at the most recent experiment. The hand drawn implantation schematic can be seen hanging on the light stand between Dr. Reshma Biniwale and Dr. Hillel Laks, who are creating the Fontan or single ventricle circulation system using gore-tex grafts. In this experiment, the team implanted a Jarvik 2000 axial flow ventricular assist device, which is about the size of a human thumb. These series of experiments successfully demonstrated the utility of axial flow ventricular assist devices as pulmonary pumps to restore cardiac output and normal hemodynamics in Fontan circulation systems. Currently, the team is investigating and designing novel implantation methods for the new HeartWare ventricular assist device.Ope

Endothelin receptor antagonism in single ventricle physiology with fontan palliation: A systematic review and meta-analysis

Background: The prevalence of single ventricle patients palliated with Fontan operation continues to grow worldwide. This study systematically reviewed existing evidence and performed a meta-analysis to determine the safety and efficacy of endothelin receptor antagonism in single ventricle physiology with Fontan palliation. Methods: Keyword and reference search was conducted in PubMed Cochrane Library, Web of Science, Google Scholar, and ClinicalTrials.gov databases. Inclusion criteria were — study design: randomized controlled trials, cohort studies, prospective studies, or retrospective studies; subjects: single ventricle patients with Fontan palliation; main outcome: exercise or functional capacity; language: English; and article type: peer-reviewed publications. Results: Five studies met the inclusion criteria, including three pre–post studies, one randomized crossover open label clinical trial, and one double-blind randomized controlled clinical trial. Study durations ranged from 3.5 to 6 months, with a total sample size of 123. Bosentan was the single endothelin receptor blocker used in all studies. No significant increase in liver toxicity or other serious adverse events were reported in these studies. Meta-analysis found bosentan use to be associated with improvement in functional class (p = 0.0007); whereas no significant change in six-minute walk distance, resting oxygen saturation, and maximal oxygen consumption was identified. Conclusions: Bosentan was found to be a safe and well tolerated endothelin receptor antagonist in Fontan patients over 3–6 months of therapy. Bosentan use was associated with improved functional capacity. Future studies with larger sample size and longer duration are warranted to examine the long-term safety and efficacy of endothelin blockade in Fontan physiology

Lower spatial QRS-T angle rules out sustained ventricular arrhythmias in children with hypertrophic cardiomyopathy

Introduction: The spatial peaks QRS-T angle accurately distinguishes children with hypertrophic cardiomyopathy from their healthy counterparts. The spatial peaks QRS-T angle is also useful in risk stratification for ventricular arrhythmias. We hypothesised that the spatial peaks QRS-T angle would be useful for the prediction of ventricular arrhythmias in hypertrophic cardiomyopathy patients under 23 years of age. Methods: Corrected QT interval and spatial peaks QRS-T angles were retrospectively assessed in 133 paediatric hypertrophic cardiomyopathy patients (12.4±6.6 years) with versus without ventricular arrhythmias of 30 seconds or longer. Significance, positive/negative predictive values, and odds ratios were calculated based on receiver operating characteristic curve cut-off values. Results: In total, 10 patients with ventricular arrhythmias were identified. Although the corrected QT interval did not differentiate those with versus without ventricular arrhythmias, the spatial peaks QRS-T angle did (151.4±19.0 versus 116.8±42.6 degrees, respectively, p<0.001). At an optimal cut-off value (124.1 degrees), the positive and negative predictive values of the spatial peaks QRS-T angle were 15.4 and 100.0%, respectively, with an odds ratio of 25.9 (95% CI 1.5–452.2). Conclusion: In children with hypertrophic cardiomyopathy, the spatial peaks QRS-T angle is associated with ventricular arrhythmia burden with high negative predictive value and odds ratio