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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.
Seminars in Cardiothoracic and Vascular Anesthesia
|March 16, 2021
Summary
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.
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