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Indications and Outcomes for Temporary Mechanical Circulatory Support in Pediatric Patients with Cardiac Failure

David W Bearl1, Robert D B Jaquiss2, Travis P Vesel3

  • 1From the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|December 14, 2018
PubMed

Insights

Temporary continuous-flow ventricular assist devices (cfVAD) offer longer support for pediatric patients than extracorporeal membrane oxygenation (ECMO), facilitating recovery, durable VAD transition, or transplant.

Area of Science:

  • Pediatric Cardiology
  • Mechanical Circulatory Support
  • Cardiovascular Surgery

Background:

  • Temporary mechanical circulatory support is crucial for pediatric patients with severe heart failure.
  • Continuous-flow ventricular assist devices (cfVAD) and extracorporeal membrane oxygenation (ECMO) are primary options.
  • Limited pediatric literature exists for temporary cfVAD use.

Purpose of the Study:

  • To compare the outcomes of temporary cfVAD and ECMO in pediatric patients.
  • To evaluate the duration of support and patient disposition for each device.
  • To assess the role of temporary cfVAD as a bridge to durable VAD or transplant.

Main Methods:

  • Single-center retrospective review of pediatric patients (<19 years) from January 2011 to June 2016.
  • Comparison of 13 patients receiving temporary cfVAD with 11 patients receiving ECMO for similar indications.
  • Analysis of precannulation data, duration of support, and patient outcomes (recovery, transplant, death).

Main Results:

  • Median cfVAD support duration was 20 days (range 6-227) vs. 9 days (range 1-15) for ECMO.
  • cfVAD patients: 1 recovered, 6 transplanted, 6 died.
  • ECMO patients: 5 recovered, 3 transplanted after durable VAD conversion, 3 died. No direct ECMO-to-transplant.
  • No significant difference in precannulation data, except higher lactate and lower pH in ECMO cohort.

Conclusions:

  • Temporary cfVAD can provide longer mechanical circulatory support in pediatric patients compared to ECMO.
  • cfVAD facilitates transition to durable VAD and subsequent heart transplantation.
  • cfVAD represents a viable option for pediatric mechanical circulatory support, improving outcomes and bridging to definitive therapy.

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