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Paracorporeal continuous-flow ventricular assist devices (cfVADs) for children less than 20 kg: Challenging the

Ryan R Davies1, Mehreen Iqbal2, Jodie Lantz-Thomason3

  • 1Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Tex; Heart Center at Children's Health, Dallas, Tex.

The Journal of Thoracic and Cardiovascular Surgery
|May 1, 2025
PubMed

Insights

Continuous-flow ventricular assist devices (cfVADs) in small children (<20kg) with heart failure show high success rates and low complication rates. This strategy challenges the use of pulsatile VADs in this vulnerable population.

Area of Science:

  • Pediatric Cardiology
  • Mechanical Circulatory Support
  • Heart Failure Management

Background:

  • Small children with heart failure face high mortality and complication risks with current VADs.
  • They are the only group not routinely managed with continuous-flow VADs (cfVADs).

Purpose of the Study:

  • To evaluate the clinical course and outcomes of an exclusive cfVAD strategy in pediatric heart failure patients.
  • To assess the efficacy and safety of cfVADs in children weighing less than 20 kg.

Main Methods:

  • Retrospective review of pediatric patients (<20 kg) supported with paracorporeal VADs (2017-2024).
  • Stratification by univentricular vs. biventricular physiology.
  • Assessment of serious adverse events, competing risks, and successful support (survival to transplant/180 days or alive on support).

Main Results:

  • 63 patients received paracorporeal cfVADs; 34.9% had prior ECMO support.
  • Successful support was achieved in 82.5% of patients (70% univentricular, 93.9% biventricular).
  • Stroke occurred in 15.9% of patients; outcomes were similar in those <5 kg.

Conclusions:

  • An all-cfVAD strategy, primarily paracorporeal, yields excellent outcomes in small pediatric heart failure patients (<20 kg).
  • High successful support rates and low neurologic complication rates were observed.
  • This approach should prompt a reevaluation of VAD selection in this population, favoring cfVADs over pulsatile devices.
Abstract

Keywords:
congenitalmechanical circulatory supportpediatricventricular assist device

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