Ventricular Assist Device Support: Single Pediatric Institution Experience Over Two Decades

Area of Science:

• Pediatric cardiology
• Cardiovascular surgery
• Biomedical engineering

Background:

• Review of a single institution's two-decade experience with pediatric ventricular assist device (VAD) support.
• Focus on improving current management and understanding future directions in pediatric VAD therapy.

Purpose of the Study:

• To analyze the evolution of pediatric VAD support over 20 years.
• To evaluate the impact of VAD type (temporary vs. durable) on clinical outcomes.
• To identify trends and advancements in pediatric mechanical circulatory support.

Main Methods:

• Retrospective review of pediatric patients undergoing VAD support from 1996 to 2017.
• Outcomes analyzed based on temporary and durable VADs.
• Primary endpoints included positive outcomes (bridge-to-transplantation, recovery, alive on device) and negative outcomes (death).
• Adverse events classified using the Pediatric Interagency Registry for Mechanical Circulatory Support definition.

Main Results:

• 201 VADs implanted in 159 pediatric patients; 82 temporary (41%) and 119 durable (59%).
• Increasing annual implant volume observed for both temporary and durable VADs.
• High positive outcomes: 80% for temporary VADs (predominantly bridge-to-recovery) and 84% for durable VADs (predominantly bridge-to-transplant).
• Introduction of continuous-flow VADs enabled routine outpatient management, with 85% of patients discharged on VADs after 2013.

Conclusions:

• Pediatric VAD support has undergone significant evolution over the past two decades.
• These advancements have positively impacted clinical outcomes for pediatric patients requiring mechanical circulatory support.
• The study provides insights into the changing landscape and future potential of VADs in pediatric care.