Unique Cannulation Technique and Atrioventricular Valve Excision for HeartWare HVAD in the Small Fontan Patient

Patients with pediatric heart failure requiring mechanical circulatory support present unique challenges. The devices employed in pediatric patients, including the HeartWare HVAD, were originally developed for adults. Proper fit and function of the device often requires creative cannulation strategies and other operative techniques due to the small size and varying anatomy of children with circulatory failure. A novel cannulation strategy that is applicable in select patients is right atrial cannulation. This location can be utilized in both univentricular and biventricular hearts. Also, excision of the systemic atrioventricular valve, including the subvalvar apparatus, is one strategy to prevent inflow obstruction to the ventricular assist device in smaller sized hearts. This technique is applicable with either apical or atrial cannulation, and in both univentricular and biventricular hearts.