Anesthetic management of children with in situ Berlin Heart EXCOR

Area of Science:

• Pediatric Cardiology
• Mechanical Circulatory Support
• Anesthesiology

Background:

• Mechanical devices support children with severe cardiac dysfunction, serving as a bridge to heart transplantation.
• Pediatric heart transplantation improves survival and quality of life but faces donor organ shortages.
• Ventricular assist devices (VADs) show better outcomes than extracorporeal membrane oxygenation as a bridge to transplantation.

Purpose of the Study:

• To highlight the increasing role of anesthesiologists in managing pediatric patients with VADs.
• To discuss the specific considerations for providing anesthesia to children with Berlin Heart EXCOR VADs.
• To outline potential VAD-specific emergencies and their management.

Main Methods:

• Review of current literature on pediatric VADs and anesthesia management.
• Discussion of the Berlin Heart EXCOR system and its application in neonates and children.
• Identification of key anesthetic considerations from preoperative assessment to postoperative care.

Main Results:

• The Berlin Heart EXCOR is a popular VAD system in pediatric practice, available in sizes for neonates.
• Postimplantation care involves managing hemodynamics, preventing thromboembolic complications, and rehabilitation.
• Anesthesiologists must be vigilant for VAD-specific emergencies like dysrhythmias, VAD failure, and embolism.

Conclusions:

• Anesthesia for pediatric patients with Berlin Heart VADs requires specialized preoperative assessment, intraoperative management, and postoperative care.
• Recognition and prompt management of VAD-specific emergencies are crucial for patient safety.
• Preparedness of anesthesiologists is essential given the increasing use of VADs in pediatric cardiac care.