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Published on: August 16, 2021
Mechanical circulatory support in pediatric patients with the MEDOS assist device
Ingo Kaczmarek1, Joerg Sachweh, Jan Groetzner
1Department Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
Insights
The MEDOS ventricular assist device (VAD) offers pulsatile mechanical circulatory support for pediatric patients awaiting heart transplants. This system demonstrated successful bridge-to-transplant outcomes, with improved organ function despite common complications.
Area of Science:
- Cardiology
- Pediatric Surgery
- Biomedical Engineering
Background:
- Mechanical circulatory support (MCS) is vital for patients with low cardiac output.
- The MEDOS-System offers pulsatile ventricular assistance across all age groups, including neonates.
Purpose of the Study:
- To evaluate the efficacy and safety of the MEDOS Ventricular Assist Device (VAD) in pediatric patients requiring mechanical circulatory support.
- To assess the MEDOS-VAD as a bridge to transplantation in a pediatric cohort.
Main Methods:
- A retrospective analysis of seven consecutive pediatric patients receiving the MEDOS-VAD.
- Data collected included patient demographics, duration of support, complications, and transplant outcomes.
Main Results:
- All seven patients received the MEDOS-VAD as a bridge to transplantation.
- Perioperative survival was 100%, with a mean support duration of 20.4 days.
- Complications included cerebral embolism/bleeding and pump thrombosis; hospital mortality was 43% due to delayed transplants.
- Secondary organ functions, such as bilirubin levels, improved during support.
- 57% of patients underwent successful heart transplantation and were discharged.
Conclusions:
- The MEDOS-System is a viable pulsatile mechanical circulatory support option for pediatric patients of all ages.
- The device can improve secondary organ function in critically ill children.
- Hemorrhage and thromboembolic events are significant complications requiring careful management.
Abstract:
Mechanical circulatory support is successfully applied to patients with low cardiac output. The MEDOS-System provides pulsatile ventricular assistance for patients of all age groups, including neonates. We report our experience with seven consecutive pediatric patients with the MEDOS-VAD. The indication was bridge to transplantation in all patients. Mean age was 7.3 +/- 6.5 years (range 0.75-16.9 years) and mean weight was 26.3 +/- 21.7 kg (range 5.9-60 kg). Perioperative survival was 100%; complications occurred in six patients (86%; two cerebral embolism/bleeding, two rethoracotomy, two exchange of pump chamber due to thrombus formation after 4 and 9 days). Mean duration of support was 20.4 +/- 10.8 days (range 6-38 days). Bilirubin decreased from 3.5 +/- 2.6 mg/d to 2.1 +/- 1.2 mg/d. Hospital mortality was three of seven patients who did not receive an organ offer in time. All patients who underwent subsequent heart transplantation (four of seven patients; 57%) were discharged from the hospital. Mechanical circulatory support with the MEDOS-System can be performed successfully in pediatric patients of any age. Secondary organ functions improve under this pulsatile circulatory assistance. Hemorrhage and thromboembolic events are the most frequent complications.
