Mechanical Circulatory Support Following Norwood Palliation

Historically, mechanical circulatory support for the newborn, particularly those with a single-ventricle physiology, such as hypoplastic left heart syndrome, has been limited to extracorporeal membrane oxygenation. The results using extracorporeal membrane oxygenation have been less than optimal, and the application of the Berlin Heart, the only pediatric ventricular assist device the Food and Drug Administration has approved to date, has also been unsuccessful. We present a compilation of techniques that can be applied to these infants. The key principle revolves around the cannulation technique (and cannula used), which involves the placement of an “aortic” cannula flush with the surface of the common atrium (avoiding any extracorporeal surface exposure within the heart chambers). Further, the application of a centrifugal pump allows for a quite effective decompression of the heart in this setting. Lastly, the described approach allows the provision of support in a rather simple fashion without the use of cardiopulmonary bypass support and without the need for a ventriculotomy.