Prolonged Mechanical Circulatory Support of Neonatal Biventricular Failure via Single Ventricle Conversion With Ventricular Assist Device

We describe a case of a newborn with biventricular failure who successfully underwent conversion to stage I single ventricle physiology with an atrial septectomy and aortopulmonary shunt placement for single ventricular assist device (SVAD) support as an alternative to neonatal biventricular assist device (BiVAD) support. She was transitioned from a paracorporeal continuous device to a paracorporeal pulsatile device, which required interval pump-upsizing and shunt angioplasty. She was well supported for more than 15 months before receiving an orthotopic heart transplant (OHT). In selected circumstances in neonatal and infant biventricular failure, single ventricle conversion and SVAD placement may be considered as an alternative to BiVAD placement, with the potential to mitigate hematologic adverse events and mortality risk and improve rehabilitation before OHT.