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An Extended Role of Continuous Flow Device in Pediatric Mechanical Circulatory Support
Ed Peng1, Richard Kirk1, Neil Wrightson1
1Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
Insights
Continuous flow ventricular assist devices (VADs) show promise for pediatric heart failure patients, offering durable support and enabling transplantation. Future smaller designs may expand use in this population.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Cardiothoracic Surgery
Background:
- Pediatric mechanical circulatory support has historically relied on pulsatile ventricular assist devices (VADs).
- Continuous flow devices have gained traction in adult heart failure, prompting investigation into their pediatric application.
- This study examines the extended use of continuous flow VADs in children under 18 years.
Purpose of the Study:
- To evaluate the efficacy and outcomes of using continuous flow ventricular assist devices (VADs) in pediatric patients.
- To assess the role of the HeartWare ventricular assist device (HVAD) in managing pediatric heart failure.
- To determine survival rates and transplantation success in pediatric VAD recipients.
Main Methods:
- A retrospective review of 12 pediatric patients (median age 7.1 years) who received a HeartWare ventricular assist device (HVAD) between 2010 and 2015.
- Patients received HVAD for cardiomyopathy or posttransplant rejection, with some requiring biventricular assist device (BIVAD) support.
- Outcomes including survival, transplantation, recovery, and duration of support were analyzed.
Main Results:
- Eight out of 12 patients (67%) successfully underwent heart transplantation.
- One patient recovered native heart function, and two patients remain on HVAD support.
- The actuarial survival rate at 1 year was 100% with no reported neurologic events.
Conclusions:
- Third-generation continuous flow VADs, such as HVAD, can provide durable mechanical circulatory support for pediatric heart failure.
- Patient selection strategies for optimal benefit are still evolving.
- Anticipated smaller device designs may broaden the application of continuous flow VADs in younger pediatric populations.
Background:
Mechanical circulatory support in the pediatric population is currently limited to pulsatile ventricular assist devices (VAD). In recent years, the use of durable, newer generation, continuous flow devices have increased substantially among adults with end-stage heart failure. We examined the extended role of this device in the pediatric population (aged less than 18 years).
Methods:
Between 2010 and 2015, 12 patients (median age 7.1 years; range, 3.7 to 17.0; one third of patients were aged 5 years or less) received a HeartWare ventricular assist device (HVAD; HeartWare, Framingham, MA), 11 for cardiomyopathy and 1 for posttransplant rejection. Right VAD support (n = 5; 42%) was provided by a short-term device (Levitronix, Zurich, Switzerland).
Results:
Overall, 1 patient died (day 638), 8 patients (67%) underwent transplantation, 1 patient (8.3%) recovered, and 2 patients (17%) remain on HVAD. The mean length of support was 150 days (range, 16 to 638). Four patients (33.3%) were discharged home (all left VAD). In the left VAD group (n = 7), 3 patients subsequently received transplants (days 185, 201, and 234, respectively), 1 recovered (day 149), 1 died (day 638), 1 remained on HVAD (day 198), and 1 needed conversion to biventricular assist device (BIVAD [day 73]). In the BIVAD group (n = 5), right VAD was weaned in 3 (60%), all subsequently received transplants, and 2 remained on BIVAD support until transplant (days 16 and 17, respectively). One BIVAD patient required conversion to central cannulation for longer-term support. Four BIVAD patients (80%) were in Interagency Registry for Mechanically Assisted Circulatory Support level 1 before VAD compared with 2 (29%) in the left VAD group (p = not significant). The actuarial survival rate was 100% at 1 year with no neurologic events.
Conclusions:
The third-generation, continuous flow device can provide durable support in the pediatric population. The selection strategy for patients who benefit most from the device continues to evolve. It is anticipated that a smaller design in the future will benefit an even wider pediatric population with heart failure.
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