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Pediatric Mechanical Circulatory Support: Introduction and Schneider's Experience
Niv Soffair1, Eran Shostak2, Ovadia Dagan2
1Pediatric Intensive Care Unit, Schneider Children's Medical Center, Petah Tikva, Israel.
Insights
Ventricular assist devices (VADs) effectively bridge pediatric heart failure patients to transplantation. This study details VAD implantation experiences and outcomes in Israeli children, highlighting successful support and transplant rates.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Medical Technology
Background:
- Ventricular assist devices (VADs) are increasingly vital for pediatric end-stage heart failure.
- VADs serve as a crucial bridge to heart transplantation for children.
- Limited published data exists on pediatric VAD experience, particularly in Israel.
Purpose of the Study:
- To present the characteristics and outcomes of VAD implantation in pediatric heart failure patients.
- To describe the use of VADs as a life-saving technology in children.
- To document the initial experience with VADs at a specific medical center in Israel.
Main Methods:
- Retrospective chart review of pediatric patients undergoing VAD implantation.
- Data collected from 2018 to 2023 at Schneider Children's Medical Center.
- Analysis of patient demographics, device types, support duration, and transplant outcomes.
Main Results:
- Fifteen children received VADs, with the youngest being 2.5 years old and weighing 11 kg.
- HeartMate 3 (continuous-flow) and Berlin Heart (pulsatile-flow) devices were used.
- Successful VAD support was achieved in 86.6% of patients, with 11 undergoing heart transplants.
Conclusions:
- VADs are an effective bridge to transplantation for pediatric end-stage heart failure.
- Careful device selection and tailored implantation techniques are crucial.
- Israeli healthcare providers should consider VADs as a viable therapeutic option for children.
Background:
Ventricular assist devices (VADs) play a critical and increasing role in treating end-stage heart failure in pediatric patients. A growing number of patients are supported by VADs as a bridge to heart transplantation. Experience with VADs in the pediatric population is limited, and experience in Israel has not been published.
Objectives:
To describe this life-saving technology and our experience with VAD implantation in children with heart failure, including characteristics and outcomes.
Methods:
We conducted a retrospective chart review of all patients who underwent VAD implantation at Schneider Children's Medical Center from 2018 to 2023.
Results:
We analyzed results of 15 children who underwent VAD implantation. The youngest was 2.5 years old and weighed 11 kg at implantation. In eight patients, HeartMate 3, a continuous-flow device, was implanted. Seven patients received Berlin Heart, a pulsatile-flow device. Three children required biventricular support; 11 underwent heart transplants after a median duration of 169 days. Two patients died due to complications while awaiting a transplant; two were still on VAD support at the time of submission of this article. Successful VAD support was achieved in 86.6% of patients. In the last 5 years,79% of our heart transplant patients received VAD support prior to transplant.
Conclusions:
Circulatory assist devices are an excellent bridge to transplantation for pediatric patients reaching end-stage heart failure. VADs should be carefully selected, and implantation techniques tailored to patient's weight and diagnosis at a centralized pediatric cardiac transplantation center. Israeli healthcare providers should be cognizant of this therapeutic alternative.
