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Centrifugal ventricular assist in children under 6 kg
C A Thuys1, R J Mullaly, S B Horton
1Victorian Paediatric Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, Australia. thuysc@cryptic.rch.unimelb.edu.au
Insights
Centrifugal ventricular assist devices (VAD) effectively support neonates and small children needing post-cardiopulmonary bypass care. This study shows VAD is a viable option for these young patients, offering encouraging outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Clinical application of centrifugal ventricular assist devices (VAD) has historically focused on adults and larger pediatric patients.
- Neonates and small pediatric patients often require ventricular support following cardiopulmonary bypass (CPB).
Purpose of the Study:
- To analyze the experience and outcomes of using centrifugal VAD in neonates and small pediatric patients weighing less than 6 kg.
- To evaluate the efficacy and safety of VAD in this specific, vulnerable patient population.
Main Methods:
- Retrospective review of VAD patients weighing less than 6 kg.
- Analysis of 35 VAD procedures in 34 patients (age range: 2-258 days, weight: 1.9-5.98 kg).
- Assessment of patient characteristics, reasons for VAD support, and outcomes including weaning, decannulation, and survival.
Main Results:
- All patients had congenital heart lesions; VAD was used post-CPB for weaning failure (71.5%) or low cardiac output (28.5%).
- Successful weaning and decannulation occurred in 63% of procedures, comparable to patients >6 kg (P=0.07).
- 1-year Kaplan-Meier survival was 31%; late deaths were primarily due to irreversible cardiac disease.
Conclusions:
- Centrifugal VAD is a realistic and manageable option for neonates and small children requiring post-CPB support.
- While no specific factors predicted successful discharge, the outcomes are encouraging for this high-risk group.
- Further research may identify predictors for improved outcomes in pediatric VAD recipients.
Objective:
The clinical application of centrifugal ventricular assist devices (VAD) has generally been limited to adults and large paediatric patients. In our experience neonates and small paediatric patients requiring ventricular support post-cardiopulmonary bypass are well supported by VAD. In this study we analyse our experience.
Methods:
We have examined the records of our VAD patients who weighed less than 6 kg. Thirty-four patients, ranging in age from 2 to 258 days (median 60 days) and weight from 1.9 to 5.98 kg (median 3.7 kg), underwent 35 VAD procedures. One patient was supported on VAD twice.
Results:
All patients had congenital heart lesions and were placed on VAD either because they could not be weaned from cardiopulmonary bypass after repair or palliation of the lesion (71.5%), or for support in the post-operative period due to refractory low cardiac output (28.5%). Twenty-two of the 35 VAD procedures (0.63, 95% CI: 0.45-0.78) resulted in successful weaning and decannulation, this was similar to the weaning probability for patients greater than 6 kg (P = 0.07). There were 10 late deaths in this group, with a 1-year KM survival of 0.31 (95% CI: 0.17-0.47). Most late deaths were related to irreversible cardiac disease processes as were the elective discontinuance of VAD outcomes. Neither weight, age, VAD duration, CPB duration, X clamp duration, univentricular anatomy or TGA anatomy predicted successful discharge from hospital (P > 0.05)--Weight P = 0.576; Age P = 0.532; VAD duration P = 0.181; CBP duration P = 0.549; X clamp duration P = 0.984; Univentricular anatomy P = 0.481; TGA anatomy P = 0.099.
Conclusion:
We believe centrifugal ventricular assist is a realistic option in very small patients who require post-cardiopulmonary bypass support. It is relatively easy to establish and manage, the results, although showing no factors predictive of successful discharge, are encouraging.