Ventricular assist devices in children: Current achievements and future perspectives

Abstract

Mechanical circulatory support systems for the treatment of acute and chronic heart failure are now available for use in several clinical situations and are designed for different indications and support times. In children, particularly in small infants, extracorporeal membrane oxygenation and centrifugal pumps have been most widely used in the past. These systems are preferred for support after cardiac operations and for use in patients who have concomitant respiratory failure, but they are suitable for short-term application only and intensive care is obligatory. VADs are designed for long-term application and allow patients to be discharged home. Pneumatic pulsatile VADs have been available in pediatric sizes since 1992. Currently at our institution, 74 children have been supported with pediatric extracorporeal VADs for up to 14 months. In the past five yr, a notable rise in survival has been achieved by improvements in pump design and pre- and post-operative management. We have been able to discharge 78% of the infants under one yr old. In this review, our current VAD experience in children will be presented in the light of improvements in decision-making, device technology, and implantation techniques, and in coagulation monitoring and anticoagulation. Additionally, new developments in the field of pediatric assist devices will be presented.

Demographics, Trends, and Outcomes in Pediatric Acute Myocarditis in the United States, 2006 to 2011

“…Current literature supports the use of VAD as a bridge to transplantation; however, the reported frequency of myocardial recovery is low. 11,12 Similar to these reports, in this study myocardial recovery was seen in only 59.6% patients who received ECMO or VAD, whereas 16.3% were successfully bridged to transplantation with 100% survival to discharge. The overall mortality rate was 7.3%.…”

Antithrombotic Therapy in Neonates and Children

“…[580][581][582] However, on the basis of adult data and the basic pathophys-ital or acquired) as either bridge to transplantation or to cardiac recovery. [621][622][623][624][625][626] There are a variety of VADs available, many specifi cally developed for pediatric use. 621 Studies of these devices in infants and children are mainly retrospective case series with outcomes being survival to transplant or to cardiac recovery.…”

“Flow and Rate”: Concept and Clinical Applications of a New Hemodynamic Theory

“…In addition CAD are generally first designed for management adult heart diseases and then miniaturized to cope with pediatric populations. However; pediatric patients are more vulnerable to hemodynamic disturbances caused by right heart failure due to congenital anomalies and they are vulnerable to vascular complications caused by small vessels geometries in content (Potapov, et al 2007). Adults usually suffer from ischemic left ventricular heart diseases with atherosclerotic vessels and they are therefore more vulnerable to vascular complications .…”