Biventricular intracorporeal ventricular assist device in a 10-year-old child

The pediatric population has benefited greatly by the evolution of ventricular assist devices (VADs) leading to miniaturization. Device design like the HeartWare® VAD allows for implantation in smaller patients or even as an implantable biventricular assist device.

A ten-year-old female patient (body surface area: 1.02 m2, 27 kg) waiting for 7 months for heart transplantation was admitted to the intensive care unit due to terminal heart failure. Transthoracal echocardiography revealed heart failure with an estimated ejection fraction of 15%, dilated left ventricle, moderate tricuspid and mitral regurgitation. Despite maximal medical therapy (including milrinone and 1 course of Levosimendan intravenous), her condition further worsened and mechanical circulatory support was indicated.After implantation of a HeartWare HVAD® device as an LVAD, a second pump was implanted as a right VAD (RVAD). The sewing ring of the HVAD was attached to the lateral wall of the right atrium. The device was implanted so that the axis of the inflow cannula was pointing towards the tricuspid valve. The outflow graft was anastomosed to the pulmonary artery truncus; the outflow graft diameter was not narrowed. Anticoagulation with IV heparin was started 8 hours postoperatively with a target antifactor Xa level of 0.3 to 0.6 IU/ml. The patient was extubated after 26 hours and fully mobilized. BVAD settings were: 2,300 revolutions per minute, calculated flow: 3.2 liters per minute and 2.7 W for the left side and 2,080 revolutions per minute, calculated flow: 3.3 L per minute and 2.1 W for the right side.