Ventricular Assist Device Support as a Bridge to Transplantation in Pediatric Patients

Abstract

For one-quarter of a century, major advances have occurred in mechanical support technology for children, thereby expanding the capability to bridge to HTx without compromising post-HTx outcomes. Significant challenges remain, especially for neonates and patients with CHD, but ongoing innovation portends improved methods of support during the next decade.

Cost‐utility of continuous‐flow ventricular assist devices as bridge to transplant in pediatrics

“…The distribution of the modeled population across health states was compared to reference literature at 12, 26, and 52 weeks. The model verification results are displayed in Supplemental Figures 1 and 2.…”

Pediatric ventricular assist devices: Bridge to a new era of perioperative care

“…The risk‐benefit profile of pediatric VAD implantation varies with multiple factors including age, weight, cardiac diagnoses, and the degree of end‐organ dysfunction . Children with dilated cardiomyopathy (DCM) have superior survival to those with CHD and children >10 years have superior survival to infants <1 year . Risk stratification by weight is important in younger children.…”

“…There is a risk for pulmonary over‐circulation from the RVAD in the pediatric population with an inability to decongest the lungs, resulting in pulmonary edema and hemorrhage. Survival after BiVAD implantation remains inferior to LVAD only, leading to its decreased use by over 50% in the most recent era . There are currently no reliable methods to predict the need for RVAD at the time of LVAD implantation although patient selection and timing of LVAD is likely to play a critical role .…”

“…Twenty percent of pediatric VAD patients have CHD with almost two‐thirds involving single ventricle (SV) physiology . Survival outcomes after VAD implantation remain inferior in CHD patients, especially in infants and small children and those with SV physiology . In particular, postcardiotomy salvage VADS involving postcardiotomy ECMO to durable VADS after congenital heart surgery have very poor outcomes .…”

“…In the current era, approximately 20%‐30% of pediatric patients awaiting heart transplant are bridged with a ventricular assist device (VAD) resulting in a 50% reduction in pediatric waitlist mortality . Since this journal's 2011 publication on mechanical circulatory support there has been more than a twofold worldwide increase in pediatric VAD implantation . Major advances include an increased use of continuous flow (CF) devices to support children, increased expertise with congenital heart disease (CHD), and a growing experience with outpatient management.…”