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Published on: July 20, 2022
The evolution of long-term pediatric ventricular assistance devices: a critical review
Louis Marcel1, Mathieu Specklin1, Smaine Kouidri1
1Arts Et Metiers Institute of Technology, CNAM, LIFSE, HESAM University, Paris, France.
Insights
Mechanical circulatory support devices offer a promising alternative for pediatric heart failure patients facing donor shortages. Engineering advancements focus on improving hemocompatibility and miniaturization for safer, long-term use.
Area of Science:
- Biomedical Engineering
- Pediatric Cardiology
- Medical Device Design
Background:
- Growing gap between pediatric heart failure patients and available heart donors.
- Mechanical circulatory support (MCS) shows short-term efficacy but requires long-term solutions.
- Pediatric patients present unique challenges for MCS due to body size and fragility.
Purpose of the Study:
- Provide an engineering perspective on the evolution of pediatric ventricular assist devices (VADs).
- Critically analyze clinical complications across VAD generations.
- Highlight design improvements and future directions for long-term pediatric MCS.
Main Methods:
- Review of existing literature on pediatric VADs.
- Analysis of engineering design principles and their impact on clinical outcomes.
- Examination of biocompatibility and hemocompatibility challenges.
Main Results:
- VAD technology has evolved significantly, addressing some initial design limitations.
- Long-term implantation in pediatric patients poses risks including shear stress-induced cell damage.
- Miniaturization and enhanced hemocompatibility are key areas for improvement.
Conclusions:
- Future pediatric VADs must prioritize hemocompatibility to preserve blood cells.
- Devices need to be adapted to pediatric systemic physiology and miniaturized.
- Engineering innovations are crucial for developing safe, long-term mechanical circulatory support for children.
Abstract:
Introduction: The gap between the number of heart failure patients and the number of potential heart donors has never been larger than today, especially among the pediatric population. The use of mechanical circulatory support is seen as a potential alternative for clinicians to treat more patients. This treatment has proven its efficiency on short-term use. However, in order to replace heart transplant, the techniques should be used over longer periods of time.Areas covered: This review aims at furnishing an engineering vision of the evolution of ventricular assistance devices used in pediatrics. A critical analysis of the clinical complications related to devices generation is made to give an overview of the design improvements made since their inception.Expert opinion: The long-term use of a foreign device in the body is not without consequences, especially among fragile pediatric patients. Moreover, the size of their body parts increases the technical difficulties of such procedure. The balance between the living cells of the body is disturbed by the devices, mostly by the shear stress generated. To provide a safe mechanical circulatory support for long-term use, the devices should be more hemocompatible, preserving blood cells, adapted to the patient's systemic grid and miniaturized for pediatric use.
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