Modified TandemHeart Ventricular Assist Device for Infant and Pediatric Circulatory Support

Kulat, Bradley; Russell, Hyde M.; Sarwark, Anne E.; Zingle, Neale R.; Moss, S.; Mongé, Michael C.; Backer, Carl L.

doi:10.1016/j.athoracsur.2014.05.093

Cited by 21 publications

(20 citation statements)

References 7 publications

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“…It is recommended by the manufacturer that the flow rate remain at greater than 1.5 L/min to decrease the risk of thrombosis. Our first modification of the VAD circuit was the addition of a variable restrictive recirculation shunt (Fig 1), enabling lower patient flow rates [6]. Our second modification has been to place an oxygenator into the circuit for hypoxic patients.…”

Section: Methodsmentioning

confidence: 99%

“…Our second modification has been to place an oxygenator into the circuit for hypoxic patients. Our surgical technique of VAD implantation has been previously described [5,6]. On cardiopulmonary bypass, the dome of the left atrium is cannulated with a standard right-angle venous cannula.…”

Section: Methodsmentioning

confidence: 99%

“…In 2012, we reported the successful use of an extracorporeal continuous-flow VAD as a bridge to transplantation in a 9-year-old girl [5]. Later, we described a modification of the VAD circuit with a variable restrictive recirculation shunt to permit lower flow ranges in small patients [6]. We now report our experience with the continuous-flow VAD as a bridge to transplantation in 13 pediatric patients.…”

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confidence: 94%

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Novel Modifications of a Ventricular Assist Device for Infants and Children

Mongé

Kulat

Eltayeb

et al. 2016

The Annals of Thoracic Surgery

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The centrifugal VAD successfully supported pediatric patients awaiting heart transplantation. The modified recirculation shunt facilitated the successful support of patients in whom optimal flows were substantially lower than those recommended by the manufacturer. The design allows placement of an in-line oxygenator. Compared with pulsatile devices, use of this VAD was associated with a trend toward decreased mortality associated with VAD use.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 94%

See 1 more Smart Citation

Novel Modifications of a Ventricular Assist Device for Infants and Children

Mongé

Kulat

Eltayeb

et al. 2016

The Annals of Thoracic Surgery

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“…It has achieved the CE Mark in Europe for use up to 30 days. Although for adults, the system has been modified to be used in children . While it is designed for LV support, it has also been applied in right‐sided and biventricular support cases .…”

Section: Clinically Used Devicesmentioning

confidence: 99%

Mechanical Circulatory Support Devices for Pediatric Patients With Congenital Heart Disease

et al. 2016

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The use of mechanical circulatory support (MCS) devices is a viable therapeutic treatment option for patients with congestive heart failure. Ventricular assist devices, cavopulmonary assist devices, and total artificial heart pumps continue to gain acceptance as viable treatment strategies for both adults and pediatric patients as bridge-to-transplant, bridge-to-recovery, and longer-term circulatory support alternatives. We present a review of the current and future MCS devices for patients having congenital heart disease (CHD) with biventricular or univentricular circulations. Several devices that are specifically designed for patients with complex CHD are in the development pipeline undergoing rigorous animal testing as readiness experiments in preparation for future clinical trials. These advances in the development of new blood pumps for patients with CHD will address a significant unmet clinical need, as well as generally improve innovation of the current state of the art in MCS technology.

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“…Advantages of the TandemHeart VAD include the simplicity of implantation and de‐airing, and reduced risk of blood trauma, hemolysis, and bleeding . Later, we described a modification of the VAD circuit with a variable restrictive recirculation shunt to permit lower flow ranges in small pediatric patients . Recently, we presented our excellent results using this device in 13 children, with a low morbidity and 100% survival rate.…”

mentioning

confidence: 99%

Successful Bridge-to-Transplant of Functionally Univentricular Patients With a Modified Continuous-Flow Ventricular Assist Device

Mongé

Kulat²,

Eltayeb

et al. 2017

Artificial Organs

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A continuous flow extracorporeal ventricular assist device (VAD) was modified to support functionally univentricular infants and children awaiting heart transplantation. A centrifugal VAD, designed to flow from 1.5 to 8 L/min, was used as a bridge-to-transplant in four patients with functionally univentricular circulation. A variable restrictive recirculation shunt permitted lower flow ranges in small patients. In hypoxic patients, an oxygenator was incorporated into the circuit. From 2012 to 2015, the modified VAD was placed in four patients with Glenn physiology. Age ranged from 0.97 to 6.98 years (median = 2.2 yrs). Body surface area ranged from 0.41 to 0.84 m (median = 0.54 m ). One patient was on extracorporeal membrane oxygenation prior to VAD. A recirculation shunt was used in three patients. Three patients required temporary use of an oxygenator for 4, 10, and 27 days. Median time on the VAD was 32.3 days (range = 23-43 days). A decrease in the cavopulmonary pressure was noted in all patients, as was a fall in the B-type natriuretic peptide. Three patients survived transplant and were discharged at 28-82 days post-transplantation. One patient died after 35 days of support. Two patients experienced major bleeding events. Two patients experienced cerebrovascular accidents, one major and one minor. The centrifugal VAD successfully supported palliated functionally univentricular patients awaiting heart transplantation. The modified recirculation shunt facilitated the successful support of patients in whom optimal flows were substantially lower than that recommended by the manufacturer. The continuous-flow VAD effectively decompressed the cavopulmonary system. The design allowed placement of an in-line oxygenator in hypoxic patients. Further investigation is required to decrease the thromboembolic events, and associated morbidity, in patients supported with this device.

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Modified TandemHeart Ventricular Assist Device for Infant and Pediatric Circulatory Support

Cited by 21 publications

References 7 publications

Novel Modifications of a Ventricular Assist Device for Infants and Children

Novel Modifications of a Ventricular Assist Device for Infants and Children

Mechanical Circulatory Support Devices for Pediatric Patients With Congenital Heart Disease

Successful Bridge-to-Transplant of Functionally Univentricular Patients With a Modified Continuous-Flow Ventricular Assist Device

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