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Right ventricular dysfunction in children supported with pulsatile ventricular assist devices

Ann Karimova1, Charissa R Pockett2, Nagore Lasuen1

  • 1Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom.

The Journal of Thoracic and Cardiovascular Surgery
|December 18, 2013
PubMed

Insights

Right ventricular dysfunction (RVD) affects 42% of pediatric ventricular assist device (VAD) recipients, with preoperative extracorporeal support and elevated urea being key risk factors for biventricular assist (BiVAD). Management of RVD in these children requires further study.

Area of Science:

  • Pediatric cardiology
  • Cardiovascular surgery
  • Biomedical engineering

Background:

  • Right ventricular dysfunction (RVD) is a significant concern in pediatric patients requiring ventricular assist devices (VADs).
  • Understanding the incidence, risk factors, and outcomes of RVD is crucial for improving patient management.
  • Previous studies have not fully elucidated the preoperative characteristics associated with RVD in this population.

Purpose of the Study:

  • To determine the incidence and severity of RVD in pediatric VAD recipients.
  • To identify preoperative factors predicting RVD development.
  • To assess the impact of RVD on outcomes, including survival and postoperative morbidity.

Main Methods:

  • A retrospective analysis of pediatric patients bridged to transplantation with VADs between 2004 and 2011.
  • RVD was defined by specific criteria including central venous pressure, inotropic support, inhaled nitric oxide duration, or requirement for biventricular assist (BiVAD).
  • Preoperative variables were analyzed to identify associations with RVD and BiVAD requirement.

Main Results:

  • Of 57 pediatric VAD recipients, 42% (24 patients) developed RVD.
  • Younger age, prior extracorporeal mechanical support, and elevated urea, creatinine, and bilirubin levels were associated with RVD.
  • Elevated urea and extracorporeal mechanical support were significant risk factors for requiring BiVAD.

Conclusions:

  • RVD occurs in approximately 40% of pediatric VAD recipients, impacting peri-implantation morbidity and bridging outcomes.
  • Preoperative extracorporeal membrane oxygenation and elevated urea are identified risk factors for BiVAD.
  • Further research into the management of RVD in pediatric VAD patients is warranted.
Abstract

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