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Extracorporeal membrane oxygenation, Berlin, and ventricular assist devices: a primer for the cardiologist
Charlotte S Van Dorn1,2, Devon O Aganga2,3, Jonathan N Johnson1,4
1Department of Pediatrics/Division of Pediatric Cardiology.
Insights
Mechanical circulatory support (MCS) options like ventricular assist devices (VADs) show promise for children with heart failure, improving survival to transplant compared to extracorporeal membrane oxygenation (ECMO). Further research is needed for complex pediatric cases.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Cardiothoracic Surgery
Background:
- Mechanical circulatory support (MCS) is crucial for pediatric patients with cardiorespiratory failure.
- Extracorporeal membrane oxygenation (ECMO) was historically the primary support, but ventricular assist devices (VADs) are increasingly used.
- Advances in VAD technology have expanded options for pediatric mechanical support.
Purpose of the Study:
- To review recent advancements in ECMO and VAD management for pediatric patients.
- To highlight the evolving landscape of mechanical support in children.
- To discuss the current state and future directions of pediatric MCS.
Main Methods:
- Literature review of recent studies on pediatric ECMO and VADs.
- Analysis of survival data and device utilization in pediatric populations.
- Examination of technological advancements and clinical outcomes.
Main Results:
- The Berlin Heart EXCOR VAD has demonstrated improved survival to transplant compared to ECMO in pediatric patients.
- Adult VADs, such as the HeartWare HVAD, are being successfully adapted for use in children.
- Significant progress has been made in the application of VADs for pediatric end-stage heart failure.
Conclusions:
- While VADs offer promising outcomes for pediatric patients, options remain limited.
- Further investigation is required for the use of VADs in smaller and more complex pediatric cases.
- Continued innovation in pediatric mechanical circulatory support is essential.
Purpose Of Review:
Mechanical circulatory support (MCS) has become an indispensable tool in the management of children with impending respiratory and cardiac failure. Though extracorporeal membrane oxygenation (ECMO) was classically the only form of support available to pediatric patients, considerable advances have allowed ventricular assist devices (VADs) to become increasingly utilized in children. This review provides an update of recent advances in ECMO and VAD management in children.
Recent Findings:
The options for mechanical support in infants and small children with end-stage heart failure are limited. As such, the greatest advances in the past decade have come in the successful adoption of the Berlin Heart EXCOR device, with a marked improvement in survival to transplant over ECMO. Further advances have been made in the use of adult VADs in children. For instance, the HeartWare HVAD has been utilized in children as young as 3 years of age, despite being designed for use in adult patients.
Summary:
The availability of mechanical support options for children remains limited to ECMO and a small number of VADs. While outcomes of VAD support in pediatric patients have been promising, further study in smaller and more complex pediatric patients is necessary.
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