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Updated: Jun 20, 2026
Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart
Published on: May 11, 2018
Outcomes of Intracorporeal Continuous and Paracorporeal Pulsatile Ventricular Assist Devices in Pediatric Patients
Jacqueline Lee1, Muhammad F Shezad2, Farhan Zafar2
1From the Herma Heart Institute, Children's Wisconsin, and Department of Pediatrics, Section of Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin.
Insights
Outcomes for intracorporeal continuous (IC) and paracorporeal pulsatile (PP) ventricular assist devices (VADs) in pediatric patients showed similar survival. Stroke risk was higher in PP VADs, though not statistically significant.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Biomedical Engineering
Background:
- Ventricular assist devices (VADs) are crucial for pediatric heart failure management.
- Paracorporeal VADs are used when intracorporeal devices are too large for smaller children.
- The comparative effectiveness of intracorporeal continuous-flow (IC) versus paracorporeal pulsatile-flow (PP) VADs in eligible pediatric patients is not well-defined.
Purpose of the Study:
- To compare survival and stroke outcomes between IC and PP VADs in pediatric patients.
- To analyze VAD performance in children weighing 10-30 kg who could potentially receive either device type.
Main Methods:
- Retrospective analysis of pediatric VAD recipients (10-30 kg) from the ACTION database (June 2018-September 2021).
- Comparison of survival and stroke rates between IC and PP VAD cohorts.
- Analysis of patient demographics, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles, and diagnoses.
Main Results:
- The study included 41 patients in the IC group and 54 in the PP group.
- The PP cohort was younger and smaller, with a higher INTERMACS profile compared to the IC cohort.
- Overall survival was comparable between IC and PP VADs; stroke events were more frequent in the PP group but not statistically significant (p=0.07).
Conclusions:
- In pediatric patients eligible for either IC or PP VADs, overall survival was similar.
- While stroke events trended higher in the PP group, direct comparisons are limited by baseline differences in patient characteristics and acuity.
- Further research is needed to clarify optimal VAD selection for this patient population.
Abstract:
Ventricular assist devices (VADs) have been increasingly implanted in pediatric patients. Paracorporeal VADs are generally chosen when intracorporeal continuous (IC) devices are too large. Superiority between IC and paracorporeal pulsatile (PP) devices remains unclear in smaller pediatric patients. Our study analyzes outcomes of IC and PP VADs in pediatric patients who could be considered for either of these options. Using the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) database, we identified children between 10 and 30 kg who received a VAD between June 2018 and September 2021. Survival and stroke outcomes were analyzed based on VAD type. There were 41 patients in the IC group and 54 patients in the PP group. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile at the time of implant was higher in the PP cohort ( p < 0.02). The PP cohort was younger ( p < 0.001) and smaller ( p < 0.001) than the IC cohort. The diagnosis was similar between cohorts. Overall survival was similar between groups. Stroke was more common in the PP cohort, but did not reach statistical significance ( p = 0.07). Discharge was possible only in the IC group, but the discharge rate was low (9.5%). Direct comparisons remain challenging given differences in INTERMACS profiles, age, and size.
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