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Long-term implantable ventricular assist device support in children
Junsang Cho1, Hari P Tunuguntla2, Sebastian C Tume3
1Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
The Journal of Thoracic and Cardiovascular Surgery
|November 1, 2023
Summary
Pediatric implantable continuous-flow ventricular assist devices (IC-VAD) can be managed at home, offering long-term support beyond temporary bridging for heart transplants. This approach improves outcomes and survival rates for children with heart failure.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Cardiothoracic Surgery
Background:
- Pediatric implantable continuous-flow ventricular assist devices (IC-VAD) are typically used as temporary support for children awaiting heart transplantation.
- These devices bridge patients to transplant within the same hospital admission.
Purpose of the Study:
- To evaluate the feasibility and outcomes of outpatient management for pediatric IC-VAD support.
- To assess the long-term efficacy of IC-VADs beyond their role as a temporary bridge to transplantation.
Main Methods:
- A retrospective review of pediatric patients who received IC-VAD support between 2008 and 2022 at a tertiary pediatric heart center.
- Analysis of patient demographics, device types, etiologies of heart failure, and clinical outcomes, including home discharge and survival rates.
Main Results:
- Out of 100 IC-VAD encounters, 94% achieved positive outcomes at 6 months (ongoing support, transplant, or recovery).
- 82% of patients were discharged home with VAD support, experiencing significantly reduced morbidity rates post-discharge.
- Overall survival at 1, 2, and 5 years was 90%, 86%, and 77%, respectively, with infection and stroke being primary causes of negative outcomes.
Conclusions:
- Outpatient management of pediatric IC-VAD support is feasible.
- Long-term VAD support can maximize the potential of these devices, extending their use beyond temporary bridging for heart transplantation.
