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Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective
Dash F T Newington1, Fabrizio De Rita1, Alan McCheyne1
1Freeman Hospital, Newcastle upon Tyne, UK.
Insights
Pediatric ventricular assist device (VAD) implantation requires significant organ support and transfusions. Infants under 12 months and those with congenital heart disease face greater challenges and poorer outcomes during VAD procedures.
Area of Science:
- Pediatric cardiac surgery
- Anesthesiology
- Mechanical circulatory support
Background:
- Ventricular assist devices (VADs) are increasingly used in pediatric patients.
- Anesthetic management guidelines for pediatric VAD implantation are limited.
Purpose of the Study:
- To characterize the pediatric VAD population.
- To describe anesthetic management strategies.
- To compare outcomes based on age (<12 months vs. >12 months) and presence of congenital heart disease.
Main Methods:
- Retrospective review of pediatric patients (0-17 years) undergoing VAD implantation.
- Data collected between 2014 and 2019 at a single center.
Main Results:
- 77 VADs implanted in 68 pediatric patients.
- High rates of preoperative support (ECMO, ventilation), intraoperative transfusions (95%), and post-VAD inotropic support (85%) were observed.
- Infants (<12 months) and patients with congenital heart disease showed higher mortality rates and required more intensive perioperative interventions.
Conclusions:
- Pediatric VAD implantation demands extensive preoperative organ support, intraoperative inotropic agents, and blood transfusions.
- Anesthetic management for VADs in infants and children with congenital heart disease is particularly complex, associated with worse outcomes.
Background:
Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures.
Aims:
To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease.
Methods:
Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019.
Results:
Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%).
Conclusions:
Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.
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