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Mechanical circulatory support of the critically ill child awaiting heart transplantation
Avihu Z Gazit1, Sanjiv K Gandhi, Charles C Canter
1Division of Pediatric Critical Care, Saint Louis Children's Hospital, Washington University School of Medicine, St Louis, Mo., USA.
Insights
Pediatric mechanical circulatory support devices aid children with heart failure awaiting transplants. This review examines current devices and outcomes, including the Berlin Heart, to improve survival rates.
Area of Science:
- Pediatric cardiology
- Mechanical circulatory support
- Biomedical engineering
Background:
- Many children awaiting heart transplants require intensive support, including mechanical ventilation and extracorporeal membrane oxygenation (ECMO).
- Limited organ availability leads to poor survival rates for these critically ill children.
- Mechanical circulatory support (MCS) is a rapidly advancing field for pediatric heart failure.
Purpose of the Study:
- To review international experiences with pediatric MCS.
- To summarize institutional experience with the Berlin Heart device since 2005.
- To compare indications, support duration, and outcomes of different MCS modalities in children.
Main Methods:
- Review of international data on pediatric mechanical circulatory support.
- Analysis of institutional experience with the Berlin Heart ventricular assist device.
- Comparative analysis of various MCS devices, including ECMO, VADs, and the Berlin Heart.
Main Results:
- The study reviews current MCS devices available for children, such as ECMO, VADs, and the Berlin Heart.
- It highlights ongoing development of new pediatric VADs supported by the National Heart, Lung, and Blood Institute.
- The paper compares outcomes based on indications, duration of support, and specific devices used.
Conclusions:
- Mechanical circulatory support offers a vital option for children with end-stage heart failure.
- Continued development and comparative analysis of devices like the Berlin Heart are crucial for improving outcomes.
- Further research and clinical trials are anticipated with the emergence of new pediatric MCS technologies.
Abstract:
The majority of children awaiting heart transplantation require inotropic support, mechanical ventilation, and/or extracorporeal membrane oxygenation (ECMO) support. Unfortunately, due to the limited pool of organs, many of these children do not survive to transplant. Mechanical circulatory support of the failing heart in pediatrics is a new and rapidly developing field world-wide. It is utilized in children with acute congestive heart failure associated with congenital heart disease, cardiomyopathy, and myocarditis, both as a bridge to transplantation and as a bridge to myocardial recovery. The current arsenal of mechanical assist devices available for children is limited to ECMO, intra-aortic balloon counterpulsation, centrifugal pump ventricular assist devices, the DeBakey ventricular assist device Child; the Thoratec ventricular assist device; and the Berlin Heart. In the spring of 2004, five contracts were awarded by the National Heart, Lung and Blood Institute to support preclinical development for a range of pediatric ventricular assist devices and similar circulatory support systems. The support of early development efforts provided by this program is expected to yield several devices that will be ready for clinical trials within the next few years. Our work reviews the current international experience with mechanical circulatory support in children and summarizes our own experience since 2005 with the Berlin Heart, comparing the indications for use, length of support, and outcome between these modalities.
