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Pediatric mechanical circulatory support - a review
Deborah Kozik1, Bahaaldin Alsoufi1
1Department of Cardiovascular and Thoracic Surgery, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, KY USA.
Insights
Pediatric mechanical circulatory support (MCS) faces challenges due to adult device size mismatches. Developing child-specific durable pumps is crucial as pediatric end-stage heart failure outpaces donor availability.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Mechanical circulatory support (MCS) history began in 1953 with heart-lung machines.
- Adult end-stage heart failure has driven faster device development compared to pediatric applications.
- Pediatric MCS has largely adapted adult devices, posing size-related challenges for smaller patients.
Purpose of the Study:
- To review available mechanical circulatory support devices for pediatric patients.
- To discuss support options for complex pediatric cases, including single-ventricle anatomy and biventricular support.
- To highlight the growing need for pediatric-specific durable pumps due to donor organ scarcity.
Main Methods:
- Review of existing literature and clinical data on pediatric mechanical circulatory support.
- Discussion of device adaptations and challenges in the pediatric population.
- Exploration of specialized support strategies for complex congenital heart defects.
Main Results:
- Adult MCS devices are often ill-suited for pediatric patients due to anatomical size discrepancies.
- A significant unmet need exists for durable, pediatric-appropriate MCS devices.
- Complex cases require tailored approaches, including biventricular assist devices and total artificial hearts.
Conclusions:
- Developing novel, size-appropriate durable mechanical circulatory support devices is critical for pediatric end-stage heart failure.
- Ongoing research and trials, such as the Pumps for Kids, Infants, and Neonates (PumpKIN) Trial, are vital.
- Registries like the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) are essential for tracking outcomes and advancing pediatric MCS.
Abstract:
The history of mechanical circulatory support began in 1953, as the first heart-lung machine enabled surgeons to perform complex open heart surgery. Heart failure is more prevalent in adults than pediatric patients which has led to the development of devices for adults with end-stage heart failure at a faster pace. Pediatric mechanical circulatory support has been derived from adult durable devices and subsequently applied in the adolescent population. The application of adult devices in children is inherently problematic due to size mismatch, especially in smaller patients. There has been an increasing interest in developing durable pumps that are appropriate for children for several reasons, with the primary factor being the number of children with end-stage heart failure far exceeding the number of potential donors. Mechanical circulatory support (MCS) for children can be divided into short-term temporary support and long-term durable support. The goal of this review is to discuss the devices available for the pediatric population and review the options for support in complex patients including single-ventricle anatomy, biventricular support, and total artificial heart options. We will also briefly discuss the Pumps for Kids, Infants, and Neonates (PumpKIN) Trial and MCS registries, including the Advanced Cardiac Therapies Improving Outcomes Network (ACTION).
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