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Supporting pediatric patients with short-term continuous-flow devices
Jennifer Conway1, Mohammed Al-Aklabi2, Don Granoski3
1Division of Cardiology, Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada.
Insights
Short-term continuous-flow ventricular assist devices (STCF-VADs) successfully bridge pediatric patients to recovery, long-term support, or transplant. These devices offer an acceptable safety profile for pediatric heart failure management.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Cardiovascular Surgery
Background:
- Short-term continuous-flow ventricular assist devices (STCF-VADs) are increasingly utilized in pediatric patients.
- Limited data exists on the outcomes of pediatric patients supported by STCF-VADs.
Purpose of the Study:
- To evaluate the outcomes and complications associated with STCF-VADs in a pediatric population.
- To assess the efficacy of STCF-VADs as a bridge to recovery, long-term VAD, or transplantation.
Main Methods:
- Retrospective single-center study of pediatric patients receiving STCF-VADs (Thoratec PediMag/CentriMag, Maquet RotaFlow) between 2005 and 2014.
- Analysis of implantation details, support duration, outcomes (weaning, conversion, transplant, death), and complications.
Main Results:
- 33 STCF-VAD runs in 27 pediatric patients, with a median support duration of 12 days.
- Successful bridging occurred in 21% to recovery, 42% to long-term VAD, and 12% to transplant.
- Common complications included bleeding (24%), neurologic events (18%), and infection (15%). Hospital discharge was achieved in 67% of admissions.
Conclusions:
- STCF-VADs provide a viable option for bridging pediatric patients with heart failure to various destinations.
- These devices demonstrate an acceptable safety profile, with potential for extended support beyond initial short-term indications.
- STCF-VADs can serve as an alternative for pediatric patients not candidates for existing long-term mechanical support devices.
Background:
Short-term continuous-flow ventricular assist devices (STCF-VADs) are increasingly being used in the pediatric population. However, little is known about the outcomes in patients supported with these devices.
Methods:
All pediatric patients supported with a STCF-VAD, including the Thoratec PediMag or CentriMag, or the Maquet RotaFlow, between January 2005 and May 2014, were included in this retrospective single-center study.
Results:
Twenty-seven patients (15 girls [56%]) underwent 33 STCF-VAD runs in 28 separate hospital admissions. The STCF-VAD was implanted 1 time in 23 patients (85%), 2 times in 2 patients (7%), and 3 times in 2 patients (7%). Implantation occurred most commonly in the context of congenital heart disease in 14 runs (42.2%), cardiomyopathy in 11 (33%), and after transplant in 6 (18%). The median age at implantation was 1.7 (interquartile range [IQR] 0.1, 4.1) years, and median weight was 8.9 kg (IQR 3.7, 18 kg). Patients were supported for a median duration of 12 days (IQR 6, 23 days) per run; the longest duration was 75 days. Before implantation, 15 runs (45%) were supported by extracorporeal membrane oxygenation (ECMO). After implantation, an oxygenator was required in 20 runs (61%) and continuous renal replacement therapy in 21 (64%). Overall, 7 runs (21%) resulted in weaning for recovery, 14 (42%) converted to a long-term VAD, 4 (12%) resulted in direct transplantation, 3 (9%) were converted to ECMO, and 5 (15%) runs resulted in death on the device or within 1 month after decannulation. The most common complication was bleeding requiring reoperation in 24% of runs. In addition, 18% of runs were associated with neurologic events and 15% with a culture-positive infection. Hospital discharge occurred in 19 of 28 STCF-VAD admissions (67%). In follow-up, with a median duration of 9.2 months (IQR 2.3, 38.3 months), 17 patients (63%) survived.
Conclusions:
STCF-VADs can successfully bridge most pediatric patients to recovery, long-term device, or transplant, with an acceptable complication profile. Although these devices are designed for short-term support, longer support is possible and may serve as an alternative approach to patients not suitable for the current long-term devices.
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