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Pediatric ventricular assist device therapy for advanced heart failure-Hong Kong experience

Inderjeet Bhatia1, Ka-Lai Cally Ho2, Barnabe Antonio Rocha2

  • 1Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China. bi546@ha.org.hk.

Journal of Artificial Organs : the Official Journal of the Japanese Society for Artificial Organs
|October 19, 2019
PubMed

Insights

Ventricular assist devices (VADs) offer life-saving support for pediatric heart failure patients. This study shows excellent survival rates, demonstrating VADs as a viable bridge to transplantation or recovery.

Area of Science:

  • Pediatric Cardiology
  • Mechanical Circulatory Support

Background:

  • Pediatric heart failure requires advanced interventions when medical therapy fails.
  • Ventricular assist devices (VADs) serve as crucial mechanical circulatory support.
  • VADs can act as a bridge to heart transplantation or facilitate cardiac recovery.

Purpose of the Study:

  • To review the outcomes of pediatric patients receiving VADs for heart failure.
  • To assess the survival rates, complications, and long-term efficacy of VADs in children.
  • To evaluate the role of VADs in managing pediatric end-stage heart disease.

Main Methods:

  • Retrospective review of 13 pediatric patients who underwent VAD implantation between 2001 and 2018.
  • Analysis of patient demographics, etiologies of heart failure, device types, duration of support, and clinical outcomes.
  • Documentation of pre-implantation support (ECMO, mechanical ventilation) and post-implantation complications.

Main Results:

  • Overall survival rate was 85% among the 13 pediatric patients.
  • Four patients were successfully bridged to heart transplantation, and three were weaned from VAD support.
  • Complications included bleeding, neurologic events, driveline infections, and pericardial effusion; overall morbidity and mortality were considered acceptable given patient severity.
  • One patient achieved a 235-day support duration with CentriMag Biventricular VAD (BIVAD), a notable duration for the Asia Pacific region.

Conclusions:

  • Ventricular assist devices demonstrate excellent survival outcomes in pediatric heart failure patients.
  • VADs are effective as a bridge to transplantation, especially considering pediatric donor shortages.
  • Despite potential complications, VAD therapy is a vital and acceptable option for critically ill children with heart failure.

Keywords:
Implantable VADParacorporeal VADTransplantationVentricular assist device-pediatric

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