Ventricular assist device use in congenital heart disease with a comparison to heart transplant

Abstract

Despite advances in medical and surgical therapies, some children with congenital heart disease (CHD) are not able to be adequately treated or palliated, leading them to develop progressive heart failure. As these patients progress to end-stage heart failure they pose a unique set of challenges. Heart transplant remains the standard of care; the donor pool, however, remains limited. Following the experience from the adult realm, the pediatric ventricular assist device (VAD) has emerged as a valid treatment option as a bridge to transplant. Due to the infrequent necessity and the uniqueness of each case, the pediatric VAD in the CHD population remains a topic with limited information. Given the experience in the adult realm, we were tasked with reviewing pediatric VADs and their use in patients with CHD and comparing this therapy to heart transplantation when possible.

Role of paediatric assist device in bridge to transplant

“…Numerous reports (26)(27)(28)(29)(30)(31)(32)(33) have validated that VADs can successfully bridge adult and paediatric heart failure patients to heart transplantation, regardless of the primary between patients bridged to transplantation with LVAD and BVAD and primary heart transplantation. 0, no VAD (primary heart transplant); 1, with VAD; VAD, ventricular assist device; LVAD, left VAD; BVAD, biventricular VAD; primHTx, primary heart transplantation.…”

HeartWare Ventricular Assist Device Implantation for Pediatric Heart Failure—A Single Center Approach

“…However, pediatric patients pose unique challenges to VAD use, given the variability in indications and size of patients. Perhaps one of the most challenging populations for VAD management are patients with congenital heart disease (CHD), which is now the most common etiology of heart failure in hospitalized children and accounts for approximately 40% of all pediatric heart transplants . In this cohort, the two patients with CHD challenged the VAD team much more than the patients with DCM.…”

Surgical strategies for the management of end‐stage heart failure in infants and children: A 15‐year experience with a patient‐tailored approach

“…Levosimendan intravenous infusion at 0.2 mcg/kg/ min for 48 hours was administered in all at least once (range 1-3), after PAB. All but one (the most recent) underwent an elective percutaneous procedure for PAB balloon dilatation, after a median of 11 (7)(8)(9)(10)(11)(12)(13)(14)(15) months from surgery, due to progressive RV hypertension and increased (≥moderate) tricuspid regurgitation. Procedures were well tolerated and patients gradually recovered from LV dysfunction, allowing delisting from HT in three cases, without recurrence of heart failure at last follow-up, as we described elsewhere.…”