Intracorporeal Biventricular Assist Devices Using the Heartware Ventricular Assist Device in Children

We describe the experience with biventricular HeartWare VAD (HVAD) support in the pediatric population. As of May 2017, using the Heartware database, 11 centers were identified. Seven centers participated providing information for 10 patients (four females, six males). Median age at the time of implantation was 12.7 ± 4.6years (5.3-6.9), median body surface area was 1.56. The indications for biventricular assist device (BiVAD) support included: myocarditis (n = 1), cardiomyopathy (n = 8), and one posttransplant heart failure. Six patients had a primary BiVAD implantation. Out of 10 patients with BiVAD, five were transplanted, one is ongoing (postoperatively day 207), and none were weaned from the device. Two patients (20%) were discharged from hospital on BiVAD support. Median support time was 52 days (16-235). The overall success rate was 60% surviving to transplant (median support time: 51 days) or are ongoing. Reasons for death included bleeding (n = 2), intracerebral hemorrhage (n = 1), and multisystem organ failure (n = 1). Eight out of 10 patients had at least one major complication, that is, major bleeding requiring re-operation (n = 6), severe neurologic injury (n = 1), and pump thrombosis in two patients requiring device exchange (n = 1) or thrombolysis therapy (n = 1). BiVAD HVAD implantation in children is a rare procedure, with high mortality and low discharge rates. Bleeding requiring re-operation was the most common postoperative complication, despite fresh sternotomies in the majority of patients. The risk and benefit ratio of such an approach should be carefully reviewed, and compared with the standard strategy using the Berlin EXCOR.