Mechanical circulatory support challenges in pediatric and (adult) congenital heart disease

Abstract

In children, there is an increased use of continuous flow devices and a growing experience with outpatient management. Patients with CHD especially when associated with single ventricle physiologies, remain a challenge when it comes to MCS/VAD placement but successful durable VAD implantation with discharge home has been reported.

The revolutionary nature of pediatric continuous-flow miniaturized devices

“…According to current European and North American registry reports, approximately 50% of children with CF LVADs support undergo heart transplantation within 3 to 6 months of initiation of mechanical support. [2][3][4]6 This may explain and support the high success rate of outcomes associated with this MCS strategy.…”

“…The major concern when using CF implantable systems in small children continues to be the patient-device size mismatch and the "official" size cut-off in use of adult devices. 6 Each of the current CF devices in clinical practice has its own approved age and BSA range, which varies, but is around 1.2 m 2 , even if CF implantable LVAD or BVAD placement has been adapted to a BSA of 1 m 2 and 0.6 m 2 . 2−8,11−13 The HVAD has clearly revolutioned the panorama of "small systems" in a "small population" of patients.…”

“…However, the Berlin Heart EXCOR (Berlin Heart GmbH) remains the "gold standard" for extremely low BSA categories. 6 Quality of life, no noise, ease of use, and confidence with the peripheral tools associated with CF VADs are superior compared with the Berlin Heart EXCOR system. 2,6 Hospital discharge and outpatient management have proven to be feasible (55% to 72% of pediatric patients in the literature 2−9,13 ) and are important factors for patients and caregivers.…”

“…5 If the indications for long-term therapy use are expanded to include patients with CHD, particularly those with singleventricle physiology, the demand for DT may be substantially increased. 6,[11][12][13] LVAD support may serve not only to improve the efficiency of failing single-ventricle circulation, but also to reliably advance the patient through the multiple stages of palliation. With the increase in the number of survivors after neonatal and infant palliative heart surgery there has been an increase in the number of patients developing ESHF.…”

Heart Failure in Adult Patients with Congenital Heart Disease

“…It is estimated that 10% to 20% of patients with ACHD will require heart transplantation at some point in their life. 38 In 2018, Esteve-Ruiz and co-workers presented the results of a series of 10 patients with ACHD undergoing heart transplantation. All of these patients suffered from failing Fontan circulation or another form of single ventricle pathology.…”