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Pulsatile pediatric ventricular assist devices: Current results for bridge to transplantation
Roland Hetzer1, Matthias Loebe, Yuguo Weng
1Department of Cardiac, Thoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
Insights
Pediatric patients can now benefit from pulsatile ventricular assist devices, offering new hope for those with heart failure awaiting transplantation. This study details their use in children, improving mechanical circulatory support options.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Cardiac Surgery
Background:
- Pulsatile ventricular assist devices (VADs) are standard for adult heart transplant candidates.
- Pediatric mechanical circulatory support has historically relied on short-term non-pulsatile systems like ECMO.
- Miniaturized pulsatile VADs are a recent advancement for pediatric heart failure.
Purpose of the Study:
- To describe the technical aspects of pulsatile VADs used in pediatric patients.
- To report the experience with the Berlin Heart assist device in children.
- To outline strategies for patient selection, perioperative care, and heart transplantation.
Main Methods:
- Review of 34 pediatric cases implanted with the Berlin Heart assist device since 1992.
- Analysis of patient demographics (age 6 days to 16 years).
- Description of implantation procedures, patient management, and outcomes.
Main Results:
- The Berlin Heart assist device has been successfully implanted in 34 children.
- The device has been used in a wide pediatric age range, from neonates to adolescents.
- The study details the clinical strategy encompassing patient selection, perioperative care, and transplantation.
Conclusions:
- Pulsatile VADs represent a viable and evolving option for pediatric mechanical circulatory support.
- The Berlin Heart assist device demonstrates feasibility in a pediatric cohort awaiting heart transplantation.
- Further research and experience are crucial for optimizing VAD therapy in children.
Abstract:
While pulsatile ventricular assist devices have gained widespread use in adult patients awaiting heart transplantation, only very limited experience with these devices exists in the pediatric population. In the past mostly non-pulsatile systems such as ECMO have been used to support pediatric patients with heart failure for very limited periods of time. Only recently have miniaturized pulsatile devices became available. This article describes the technical characteristics of these devices which have been implanted at the Deutsches Herzzentrum Berlin since 1992. The Berlin Heart assist device has since been used in 34 children between the ages of 6 days and 16 years. We report our strategy in patient selection, perioperative care and subsequent heart transplantation. The current literature on mechanical circulatory support in children is reviewed. Copyright 1999 by W.B. Saunders Company