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Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
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Pulmonary Vasodilator Therapy in Pediatric Patients on Ventricular Assist Device Support: A Single-Center Experience

Jennifer E Schramm1, John C Dykes2, Rachel K Hopper2

  • 1From the Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|August 9, 2023
PubMed

Insights

Prostacyclin therapy is safe for pediatric patients with high pulmonary vascular resistance (PVR) on ventricular assist devices (VADs). This treatment may improve transplant candidacy for high-risk children.

Area of Science:

  • Cardiology
  • Pediatric Critical Care
  • Pulmonary Hypertension

Background:

  • Pediatric pulmonary hypertension can arise from systemic atrial hypertension, complicating ventricular assist device (VAD) support.
  • Elevated pulmonary vascular resistance (PVR) post-VAD may preclude heart transplant candidacy.
  • Limited pediatric data exists on prostacyclin use in VAD patients.

Approach:

  • Retrospective review of 17 pediatric patients on VAD support with high PVR treated with prostacyclins (2016-2021).
  • Analysis of safety, efficacy, and perioperative protocol for intravenous epoprostenol or treprostinil.
  • Evaluation of transplant survival rates and complications.

Key Points:

  • No bleeding complications or end-organ dysfunction worsening observed with continuous IV prostacyclin therapy.
  • Significant 49% reduction in vasoactive inotropic scores within 24 hours of prostacyclin initiation.
  • 12 of 17 patients (70.6%) survived to heart transplant; 1 remains alive with VAD.

Conclusions:

  • Prostacyclins appear safe for pediatric VAD patients with elevated PVR.
  • This therapy may offer a viable transplant option for high-risk pediatric patients.
  • Successful post-transplant outcomes were achieved in all patients who received transplants.

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