Thoratec ventricular assist devices in children with less than 1.3 m2 of body surface area

This report summarizes the multicenter experience with the Thoratec paracorporeal pneumatic ventricular assist device (VAD) (Thoratec Corp., Pleasanton, CA) in small children. Between October 1988 and August 2001, 19 children (11 male, 8 female) with less than 1.3 (mean 1.09, range 0.73-1.29) m2 body surface area (BSA) have been supported with univentricular (9) or biventricular (10) Thoratec VADs in 12 centers in the United States and Germany. Mean patient age was 10 (range 7-14) years, mean weight 31 (range 17-41) kg. Indications for support were end-stage cardiomyopathy in eight patients, myocarditis in three, end-stage congenital heart disease in seven, and transplant graft failure in one patient. Mean duration of support was 43 (range 0-120) days. In patients with cardiomyopathies and myocarditis, survival through discharge occurred in 8 of 11 (72%) patients; however, only 1 of 7 patients with congenital disease survived. Outcome appeared independent of patient size. Neurologic complications were significant and predominant in the congenital disease group. Our experience suggests that the Thoratec VAD can be successfully used in these difficult patients, particularly in children with cardiomyopathies and myocarditis. Congenital disease is associated with increased risk. To reduce thromboembolic risk, we recommend left ventricular as opposed to left atrial inflow cannulation and higher device rates with partial stroke volumes.