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Pediatric mechanical circulatory support: available devices and outcomes as bridge-to-transplant therapy
Angela Lorts1, Elizabeth D Blume
1aThe Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio bThe Heart Center, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Pediatric ventricular assist device (VAD) therapy is improving outcomes for children needing heart transplants. Careful patient selection and ongoing monitoring are crucial for this advanced treatment.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Cardiac Surgery
Background:
- Mechanical circulatory support (MCS) use in pediatric patients has significantly increased.
- Existing literature on pediatric ventricular assist devices (VADs) requires review to enhance patient care.
- Advancements in VAD technology enable application in smaller and younger patients.
Purpose of the Study:
- To review the current pediatric VAD literature.
- To identify strategies for improving outcomes in pediatric VAD recipients.
- To refine patient selection criteria for VAD implantation in children.
Main Methods:
- Comprehensive literature review of pediatric VAD studies.
- Analysis of outcomes data for pediatric patients bridged to transplant with VADs.
- Evaluation of current trends in device selection and surgical planning.
Main Results:
- Pediatric VAD therapy shows improving outcomes for bridge-to-transplant cases.
- Patient selection in pediatric VADs is complex due to size and unique anatomy.
- Innovative applications, such as long-term use of temporary devices, are emerging.
- Device selection, surgical planning, and managing sensitization/adverse events are critical considerations.
- A national registry is vital for monitoring outcomes of this complex therapy.
Conclusions:
- Ventricular assist device (VAD) therapy is becoming a standard of care for pediatric bridge-to-transplant.
- Improving and expanding the use of durable VADs in children has significant implications.
- Continuous outcome surveillance is essential for optimizing patient selection and minimizing adverse events in pediatric advanced heart failure.
Purpose Of Review:
The use of mechanical circulatory support in children has increased dramatically over the current decade. A review of the pediatric ventricular assist device (VAD) literature is timely and relevant in order to improve outcomes and refine patient selection as new devices become available and current VADs are used in smaller patients.
Recent Findings:
Outcomes of pediatric patients bridged to transplant with VAD therapy continue to improve. Patient selection in children continues to be complex as size and anatomy make decision-making unique from the adult practice. In addition, device selection and surgical planning are evolving in children. The use of temporary devices for long-term use is an example of an innovative application of current technology. Sensitization and adverse events are important issues that are necessary to understand in order to improve outcomes. The importance of a national registry to help monitor patient outcomes is critical to assessing this highly technological therapy.
Summary:
There are many implications of improving and expanding durable device use in children. VAD therapy is evolving as a standard of care as a bridge to transplant in children. Continued surveillance of outcomes is critical to improving patient selection and decreasing adverse events in children with advanced heart failure.
