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Implementing a Programmatic Approach to Identify and Promote Ventricular Recovery in Pediatric Patients Supported

Catherine M Montgomery1, Radhika Rastogi1, Aaron Dewitt2

  • 1Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania Philadelphia PA USA.

Journal of the American Heart Association
|January 22, 2026
PubMed

Insights

A standardized program for ventricular recovery in pediatric patients with durable ventricular assist devices led to device explant in 26% of cases. Outcomes were encouraging, particularly for patients without congenital heart disease (CHD).

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Medical Device Technology

Background:

  • A standardized program was implemented in October 2022 to enhance ventricular recovery in pediatric patients using durable ventricular assist devices (VADs).
  • This initiative aimed to improve outcomes and explore possibilities for device explant or alternative surgical palliation.

Purpose of the Study:

  • To evaluate the effectiveness and outcomes of a standardized approach to promoting ventricular recovery in pediatric VAD recipients.
  • To identify patient characteristics and factors influencing successful ventricular recovery and device explant.

Main Methods:

  • A retrospective cohort study included pediatric patients with durable VADs implanted between October 2022 and October 2024.
  • The program involved a cultural shift towards recovery assessment, goal-directed medical therapy, stepwise recovery evaluation (echocardiography, exercise testing, cardiac catheterization), and multidisciplinary review.
  • Outcomes were analyzed for patients explanted due to recovery.

Main Results:

  • The study included 35 patients (22 Berlin Heart EXCOR, 13 HeartMate 3) with indications including cardiomyopathy (60%), congenital heart disease (CHD, 31%), and others.
  • Nine patients (26% of total, 38% of non-CHD patients) underwent successful device explant for recovery; all were discharged postexplant.
  • No patients with CHD met recovery criteria. Short-term follow-up showed sustained recovery in most explanted patients, with one patient relisted for transplant.

Conclusions:

  • A standardized VAD program successfully facilitated ventricular recovery and device explant in 26% of pediatric patients, exclusively in those without CHD.
  • Short-term postexplant outcomes are promising, suggesting the need for further investigation in larger patient cohorts.
Abstract

Keywords:
cardiologypediatricsventricular assist deviceventricular recovery

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