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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Evaluation of thrombosis and bleeding events in the children with left ventricular assist device (L-VAD)
Pelin Elibol1, Zulal Ulger1, Cagatay Engin2
1Department of Pediatric Cardiology, Ege University, Izmir, Turkiye.
Insights
Ventricular assist devices (VADs) in pediatric heart failure patients show acceptable bleeding and thrombosis risks, enabling successful heart transplantation. Further VAD advancements are needed to improve transplant rates.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Pediatric end-stage heart failure necessitates advanced mechanical circulatory support.
- Ventricular assist devices (VADs) are crucial for bridging children to heart transplantation.
- Evaluating VADs' safety and efficacy in pediatric populations is essential.
Purpose of the Study:
- To compare thrombosis and bleeding events in children receiving two types of VADs.
- To assess the impact of VADs on bridge-to-transplantation rates and survival outcomes.
- To analyze the safety profile of VADs in pediatric end-stage heart failure.
Main Methods:
- Retrospective study of 26 pediatric patients with end-stage heart failure.
- Inclusion of patients implanted with either Berlin Heart EXCOR (BHE) or HeartWare (HW) VADs.
- Systematic recording of bleeding events, thrombosis events, transplantation, and survival data.
Main Results:
- Overall, 33.3% of patients experienced bleeding events and 66.7% experienced thrombosis events.
- No significant difference in thrombotic or bleeding events between BHE and HW groups.
- Mortality occurred in 34.6% of patients, and 53.8% achieved bridge-to-transplantation.
Conclusions:
- VAD implantation in pediatric heart failure facilitates successful heart transplantation with manageable risks.
- Current VAD technologies present acceptable risks of bleeding and thromboembolic events.
- Improved VAD technology and hematologic complication management are vital for enhancing pediatric heart transplant rates.
Abstract:
This study aimed to evaluate thrombosis and bleeding events in the children implanted with two types of ventricular assist devices (VAD). A total of 26 paediatric end-stage heart failure patients with the mean age of 11.32 ± 4.17 years, 15 were boys, implanted with a VAD, either the Berlin Heart EXCOR (BHE group; n = 9) or the HeartWare (HW group, n = 17), were included in this retrospective study. Follow up data on bleeding events, thrombosis events, bridge-to-transplantation rates and survival outcome were recorded. Overall, 16(33.3%) bleeding events and 32(66.7%) thrombosis events occurred, while 14(53.8%) patients had at least one thrombotic event and 8(30.8%) patients had at least one bleeding event. BHE and HW groups were similar in terms of number of patients with at least one thrombotic (33.3% vs. 64.7%, p = .218) or bleeding (22.2% vs.35.3%, p = .399) event. Mortality occurred in 9(34.6%) patients and 13(50.0%) patients achieved bridge-to-transplantation, similarly in BHE and HW groups (mortality: 44.4% vs. 29.4%, p = .667 and transplantation: 77.8% vs. 35.3%, p = .097). In conclusion, our findings revealed that VAD application in children with heart failure enables successful heart transplantation achievement with an acceptable risk of bleeding/thromboembolic events in most of cases. More advanced VAD technologies and more successful management for haematologic complications are necessary to improve the transplantation rates in children.
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