Right ventricular dysfunction in children supported with pulsatile ventricular assist devices

Karimova, Ann; Pockett, Charissa; Lasuen, Nagore; Dedieu, Nathalie; Rutledge, John; Fenton, Matthew; VanderPluym, Christina; Rebeyka, Ivan M.; Dominguez, Troy E.; Buchholz, Holger

doi:10.1016/j.jtcvs.2013.11.012

Cited by 34 publications

(32 citation statements)

References 23 publications

(40 reference statements)

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“…2 In light of pulsatile blood flow's benefit for myocardial recovery, perfusion of coronary arteries and end organs, pulsatile VADs are still widely used as paracorporeal mechanical circulatory support devices in clinical applications, especially in pediatric heart failure patients. [3][4][5] However, adverse events associated with VAD blood damage usually occur in clinical applications. [6][7][8] The blood damage of VADs includes not only hemolysis but also thrombosis.…”

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confidence: 99%

The Influence of Different Operating Conditions on the Blood Damage of a Pulsatile Ventricular Assist Device

et al. 2015

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Because of pulsatile blood flow's benefit for myocardial recovery, perfusion of coronary arteries and end organs, pulsatile ventricular assist devices (VADs) are still widely used as paracorporeal mechanical circulatory support devices in clinical applications, especially in pediatric heart failure patients. However, severe blood damage limits the VAD's service period. Besides optimizing the VAD geometry to reduce blood damage, the blood damage may also be decreased by changing the operating conditions. In this article, a pulsatile VAD was used to investigate the influence of operating conditions on its blood damage, including hemolysis, platelet activation, and platelet deposition. Three motion profiles of pusher plate (sine, cosine, and polynomial), three stroke volumes (ejection fractions) (56 ml [70%], 42 ml [52.5%], and 28 ml [35%]), three pulsatile rates (75, 100, and 150 bpm), and two assist modes (copulsation and counterpulsation) were implemented respectively in VAD fluid-structure interaction simulations to calculate blood damage. The blood damage indices indicate that cosine motion profile, higher ejection fraction, higher pulsatile rate, and counterpulsation can decrease platelet deposition whereas increase hemolysis and platelet activation, and vice versa. The results suggest that different operating conditions have different effects on pulsatile VAD's blood damage and may be beneficial to choose suitable operating condition to reduce blood damage in clinical applications.

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confidence: 99%

The Influence of Different Operating Conditions on the Blood Damage of a Pulsatile Ventricular Assist Device

et al. 2015

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“…Thirty-six to thirty-eight percent of patients in the EXCOR IDE study required biventricular support [8 • , 9 • ]. Other groups have reported similar rates of RVAD support, ranging from 25 [53] to 33 % [10]. Data suggests that the increased need for BiVAD support in pediatrics may be secondary to center experience and not necessarily due to a increased frequency of right ventricular failure.…”

Section: Pediatric Specific Issues Biventricular Supportmentioning

confidence: 85%

Children Are Not Small Adults: Options for Pediatric Ventricular Assist Devices

2015

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The number of children supported with ventricular assist devices (VADs) has grown rapidly over the last few years. VAD use in children holds the promise of improving the outcomes in pediatric end-stage heart failure; however, the risk-benefit profile inherent to VAD use is not uniform across all ages, sizes, and diagnoses. Device use in children has underscored a number of issues that distinguish pediatric and adult heart failure such as the high prevalence of complex congenital heart disease and the challenges inherent to supporting infants and small children. The use of VADs in children also raises a range of social, emotional, and logistic changes unique to children across the age spectrum.

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“…For that reason BiVAD support is more often necessary in pediatric patients with reports of BiVAD utilization occurring in 25–45% [7, 21, 22]. Patients who receive BiVAD support clearly have a reduced survival demonstrated in multiple studies [3, 22–24].…”

Section: Device and Implantation Characteristicsmentioning

confidence: 99%

Current approaches to device implantation in pediatric and congenital heart disease patients

Miller

Lancaster

Eghtesady³

2015

Expert Review of Cardiovascular Therapy

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Summary The pediatric ventricular assist device (VAD) has recently shown substantial improvements in survival as a bridge to heart transplant for patients with end-stage heart failure. Since that time, its use has become much more frequent. With increasing utilization, additional questions have arisen including patient selection, timing of VAD implantation and device selection. These challenges are amplified by the uniqueness of each patient, the recent abundance of literature surrounding VAD use, as well as the technological advancements in the devices themselves. Ideal strategies for device placement must be sought, for not only improved patient care, but for optimal resource utilization. Here, we review the most relevant literature to highlight some of the challenges facing the heart failure specialist, and any physician, who will care for a child with a VAD.

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Right ventricular dysfunction in children supported with pulsatile ventricular assist devices

Cited by 34 publications

References 23 publications

The Influence of Different Operating Conditions on the Blood Damage of a Pulsatile Ventricular Assist Device

The Influence of Different Operating Conditions on the Blood Damage of a Pulsatile Ventricular Assist Device

Children Are Not Small Adults: Options for Pediatric Ventricular Assist Devices

Current approaches to device implantation in pediatric and congenital heart disease patients

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