Outcomes of ventricular assist device support in young patients with small body surface area

Area of Science:

• Pediatric Cardiology
• Mechanical Circulatory Support
• Heart Failure Management

Background:

• Ventricular assist devices (VADs) are established for adults with advanced heart failure.
• Limited data exists on VAD use in infants and young children due to small body surface area.
• Mechanical circulatory support is crucial for pediatric end-stage heart disease.

Purpose of the Study:

• To evaluate the safety and efficacy of the Berlin Heart EXCOR pediatric VAD in small children.
• To assess survival rates and outcomes in pediatric patients requiring mechanical circulatory support.
• To analyze factors influencing survival in young VAD recipients.

Main Methods:

• A retrospective analysis of 56 pediatric patients with body surface area <1.2 m² implanted with the Berlin Heart EXCOR VAD.
• Patients were implanted between January 1999 and December 2009 at the Germany Heart Institute Berlin.
• Etiologies included non-congenital (75%) and congenital (25%) heart disease; median age was 1 year.

Main Results:

• Survival on VAD support was 81.1% ± 5.8% at 30 days and 51.4% ± 9.3% at 1 year post-implantation.
• 24 patients were bridged to heart transplantation, 12 recovered myocardial function, and 18 died on support.
• Higher mortality trend was observed with biventricular support and in patients with congenital heart disease.

Conclusions:

• The Berlin Heart EXCOR pediatric VAD provides satisfactory and safe mechanical circulatory support for small children with end-stage heart disease.
• The device is a viable option for pediatric patients awaiting heart transplantation or recovery.
• Congenital heart disease and biventricular support were associated with poorer outcomes.