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Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart
Published on: May 11, 2018
Technology insight: Use of ventricular assist devices in children
Roland Hetzer1, Brigitte Stiller
1Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin, Germany. hetzer@dhzb.de
Insights
Mechanical circulatory support systems, including ventricular assist devices (VADs), significantly improve survival rates in pediatric patients with heart failure. Long-term VAD support enables mobilization and recovery for children with myocarditis and cardiomyopathy.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Critical Care Medicine
Background:
- Mechanical circulatory support (MCS) is crucial for end-stage heart failure.
- Extracorporeal membrane oxygenation (ECMO) and centrifugal pumps are used short-term in children, especially infants, often with respiratory failure.
- True ventricular assist devices (VADs) offer long-term support and patient mobilization.
Purpose of the Study:
- To review current ventricular assist device (VAD) experience in pediatric patients.
- To highlight improvements in VAD technology, implantation, and management for children.
- To assess the impact of VADs on survival and recovery in pediatric myocarditis and cardiomyopathy.
Main Methods:
- Review of institutional experience with VADs in 70 infants and children over 5 years.
- Analysis of VAD support duration, ranging from days to 14 months.
- Focus on pneumatic pulsatile VADs available in pediatric sizes since 1992.
Main Results:
- VAD use has led to a notable increase in survival for pediatric patients with myocarditis and cardiomyopathy.
- 78% of infants under 1 year old supported with VADs were discharged.
- Long-term VAD application facilitated patient mobilization and potential for cardiac recovery.
Conclusions:
- Ventricular assist devices (VADs) are effective for long-term circulatory support in pediatric heart failure.
- Improvements in decision-making, device technology, and management have enhanced VAD outcomes in children.
- VADs offer a vital treatment option for pediatric patients awaiting transplantation or recovering from cardiac conditions.
Abstract:
Mechanical circulatory support systems for the treatment of end-stage heart failure are now available for a wide variety of clinical situations and support times. Extracorporeal membrane oxygenation and centrifugal pump circuits have been most widely used in children, particularly in small infants. These systems are preferred for support after cardiac operations and for use in patients who have concomitant respiratory failure, but are suitable for short-term application only and intensive care is obligatory. True ventricular assist devices (VADs) qualify for long-term application and allow patients full mobilization. These features are important in patients awaiting heart transplantation as well as in those with myocarditis and cardiomyopathy, who might achieve complete cardiac recovery. Pneumatic pulsatile VADs have been available in pediatric sizes since 1992. At our institution, VAD use lasting from several days to 14 months in 70 infants and children with myocarditis and cardiomyopathy has led to a notable rise in survival in the past 5 years. We have been able to discharge 78% of the infants under 1 year old. In this review we present current VAD experience in children in the light of improvements in decision making, device technology, implantation techniques, and in coagulation monitoring and anticoagulation.
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