Implantation of a Durable Left Ventricular Assist Device in Patients With Adult Congenital Heart Disease

Ventricular assist device (VAD) in adult congenital heart disease (ACHD) patients remains technically demanding because of complex anatomy, prior surgical interventions, and hemodynamics. This study aimed to describe anatomical and device-related challenges during durable VAD support in ACHD patients. We retrospectively reviewed ACHD patients who underwent durable VAD implantation at a single institution between 2012 and 2023. Clinical and anatomical characteristics were analyzed. Four ACHD patients (median age, 37 years) underwent VAD implantation for end-stage heart failure. Primary disease was l- and d-transposition of the great arteries and atrioventricular septal defect. All patients had complex anatomy and extensive surgical histories. Ventricular assist device implantation required individualized surgical strategies, including device placement in the expanded thoracic space and nonstandard inflow and outflow graft configurations, and concomitant procedures. During long-term follow-up, patients experienced diverse complications such as driveline infection with gastrointestinal erosion and external outflow graft obstruction due to mediastinal compression. Two patients were successfully bridged to heart transplantation, whereas one patient died of sepsis, and one patient is alive on a device. Ventricular assist device therapy in ACHD patients is feasible but is associated with unique anatomical and device-related challenges. Careful surgical planning, individualized surgical approaches, and vigilant long-term management may help optimize VAD support in this complex population.