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Mechanical circulatory support in pediatrics
Robert J Steffen1, Kyle G Miletic1, Dean P Schraufnagel1
1a Department of Thoracic and Cardiovascular Surgery , Heart and Vascular Institute, Cleveland Clinic , Cleveland , OH , USA.
Insights
Mechanical circulatory support devices aid children with end-stage heart failure. Newer ventricular assist devices (VADs) show promise, with ongoing research focusing on novel applications and improved durability for pediatric patients.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Mechanical Circulatory Support
Background:
- End-stage heart failure impacts thousands of children annually, necessitating advanced medical interventions.
- Mechanical circulatory support (MCS) plays a crucial role throughout pediatric cardiac care.
- Extracorporeal membrane oxygenation (ECMO) supports failing heart and lung function, utilized in resuscitation and post-operative shock.
Purpose of the Study:
- To review the current landscape and future directions of mechanical circulatory support in pediatric patients.
- To highlight advancements in ventricular assist devices (VADs) for children.
- To identify emerging applications and areas for improvement in pediatric MCS.
Main Methods:
- Review of current literature on pediatric mechanical circulatory support.
- Discussion of existing technologies like ECMO and VADs.
- Exploration of novel applications for congenital heart defects.
Main Results:
- Continuous-flow VADs are increasingly adopted, showing promising initial results in pediatric populations.
- The Berlin paracorporeal pulsatile VAD is the sole FDA-approved VAD for pediatric use.
- Univentricular hearts and complex congenital lesions represent new frontiers for MCS.
Conclusions:
- Pediatric mechanical circulatory support is evolving, with a focus on adapting devices for complex congenital conditions.
- Continued innovation is essential to enhance VAD durability and minimize complications in children.
- Future research should explore novel uses and optimize existing MCS technologies for pediatric end-stage heart failure.
Abstract:
End-stage heart failure affects thousands of children yearly and mechanical circulatory support is used at many points in their care. Extracorporeal membrane oxygenation supports both the failing heart and lungs, which has led to its use as an adjunct to cardiopulmonary resuscitation as well as in post-operative cardiogenic shock. Continuous-flow ventricular assist devices (VAD) have replaced pulsatile-flow devices in adults and early studies have shown promising results in children. The Berlin paracorporeal pulsatile VAD recently gained U.S. Food and Drug Administration approval and remains the only VAD approved in pediatrics. Failing univentricular hearts and other congenitally corrected lesions are new areas for mechanical support. Finding novel uses, improving durability, and minimizing complications are areas of growth in pediatric mechanical circulatory support.
