Ventricular assist device support in children and adolescents as a bridge to heart transplantation

Mahesh S Sharma, Steven A Webber, Victor O Morell, Sanjiv K Gandhi, Peter D Wearden, Julianne R Buchanan, Robert L Kormos
Annals of Thoracic Surgery 2006, 82 (3): 926-32

BACKGROUND: Mechanical circulatory support using ventricular assist devices (VADs) is a life-saving option for children in heart failure refractory to maximal medical management. The aim of this study was to evaluate the efficacy of standard adult VADs in adolescents and children as well as report our early experience with miniaturized VADs in small children.

METHODS: A 15-year retrospective review was performed on all patients younger than 18 years of age undergoing insertion of a pulsatile VAD at our institution.

RESULTS: Eighteen patients underwent VAD placement during the study period. The mean age was 12 (range, 6 months to 18 years), with a mean body surface area of 1.48 (range, 0.25 to 2.3 m2). Diagnoses included dilated cardiomyopathy (n = 15), myocarditis (n = 2), and postcardiotomy ventricular failure (n = 1). Ten children underwent insertion of biventricular VADs, and 8 had implantation of left ventricular VADs. The mean support duration was 57 days (range, 2 to 175 days). Complications included bleeding requiring reoperation (n = 4), stroke (n = 5), and device-related infection (n = 2). Outcomes of VAD support were as follows: VAD explantation in 1 case, death while receiving mechanical support in 3 patients, and successful transplantation in 14 patients (77%). Survival at 6 months after orthotopic heart transplantation was 93% with 1-year and 5-year survival rates of 83%.

CONCLUSIONS: Currently available VADs are applicable for use as a bridge to orthotopic heart transplantation or in rare instances for myocardial recovery. The increasing accessibility of miniaturized devices allow for long-term support in smaller children and infants while awaiting orthotopic heart transplantation. Although the perioperative morbidity and mortality of VAD placement is not insignificant, survival for those who receive a heart transplant is excellent.

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