Explantation of durable ventricular assist device for myocardial functional recovery in children: A report from the...

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Biomedical Engineering

Background:

• Ventricular assist device (VAD) explantation after myocardial functional recovery (MFR) is uncommon in pediatric patients.
• The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry provides data on these rare cases.

Purpose of the Study:

• To investigate the characteristics and outcomes of durable VAD explantation following MFR in children.
• To assess the VAD and heart transplant-free survival rates in this pediatric cohort.

Main Methods:

• Analysis of durable VAD explants (intracorporeal continuous flow and paracorporeal pulsatile devices) from the ACTION registry (March 2012 - August 2023).
• Exclusion of temporary VAD devices.
• Primary outcome: VAD and heart transplant-free survival post-explantation.

Main Results:

• 3.3% (31/938) of pediatric patients underwent durable VAD explantation for MFR.
• Median VAD support was 111 days; median age 1.17 years.
• Most common diagnosis: dilated cardiomyopathy/myocarditis (64%).
• Post-explantation: 10% reimplanted VAD, 14% received heart transplant, 3.4% died.
• 72% survived without advanced therapies at 2-year follow-up.

Conclusions:

• Myocardial functional recovery leading to VAD explantation is infrequent in children.
• The majority of pediatric patients achieve good outcomes without requiring further advanced heart failure therapies.
• Further research is needed to identify optimal candidates for VAD explantation and predictors of MFR.