Sequential external ventricular support in a patient with total cavo-pulmonary connection

The survival of patients with congenital heart disease awaiting heart transplantation or in recovery has improved with Ventricular Assist Devices (VADs). However, results are poor in patients with single ventricle physiology. We present a 16-year-old male with a single double-inlet ventricle, with total cavo-pulmonary connection, whose cardiological symptoms worsen rapidly. The first examination revealed a decreased left ventricular ejection fraction (15 %) and multi-organ failure. After admission to the PICU and stabilization with high doses of inotropes, it was decided to place an ECMO with Levitronix Centrimag. A sequential removal of the support was carried out, as same as the one that has been performed in the “Regina Marguerita Children's Hospital”, removing the Fontan inflow cannula and the oxygenator on the 4th day. On the 15th day of attendance, during the postoperative period, the patient presented septic shock with isolation of Serratia marcescens in the blood cultures, with rapid deterioration of the clinical status of the patient and death on the 17th day. Better patient selection with a good VAD implantation strategy, such as the sequential removal method, could provide successful mechanical support in these patients. Our patient presented good hemodynamic adaptation; however, he died due to an infectious complication. •The high rate of failure in ventricular assist in patients with single ventricle is due not only to hemodynamic failure.•The conditions in which the patients are prior to ventricular assistance also influence.•A new sequential approach could provide better hemodynamic adaptation in patients with total cavo-pulmonary connection.