Centrifugal-flow ventricular assist device support in children: A single-center experience

Abstract

Background: Our institutional policy is to continue centrifugal-flow ventricular assist device support for 3 months or more without activation on the transplant wait-list for physical recovery and assessment of possible myocardial recovery. We evaluated our single-institutional outcomes with centrifugal-flow ventricular assist device support in children.Methods: Prospectively collected outcomes data in consecutive patients aged 18 years or less with centrifugal-flow ventricular assist device support were reviewed.

The Year in Review: Anesthesia for Congenital Heart Disease 2019

“…35 There was no significant difference in rejection, infection, posttransplant lymphoproliferative disorder, or renal function between VAD and non-MCS groups. 36 Adachi et al published their single-center outcomes utilizing a protocol of CF-VAD support in children prior to listing for heart transplantation. 36 They analyzed outcomes of 40 implantations on 39 patients, ages 4 to 18 years, with a median body surface area of 0.7 to 2.2 m 2 , with 11 patients having a diagnosis of CHD and the remainder diagnosed with cardiomyopathy.…”

“…36 Adachi et al published their single-center outcomes utilizing a protocol of CF-VAD support in children prior to listing for heart transplantation. 36 They analyzed outcomes of 40 implantations on 39 patients, ages 4 to 18 years, with a median body surface area of 0.7 to 2.2 m 2 , with 11 patients having a diagnosis of CHD and the remainder diagnosed with cardiomyopathy. Patients with a non-CHD diagnosis were implanted with a centrifugal VAD, and listing for transplantation was delayed for 3 months or more while medical therapy was maximized and cardiac recovery monitored.…”

“…Analysis of adverse events revealed that 54% of adverse events occurred in 23% of the patients, with 78% having fewer than 3 complications, and 25% having no complications. 36 Adverse events evaluated included bleeding, device malfunction, infection, neurological dysfunction, pericardial drainage, and renal dysfunction. Body surface area less than 1 m 2 was associated with increased rates of all adverse events save renal dysfunction.…”

Pediatric ventricular assist device support as a permanent therapy: Clinical reality

“…At 3 months after continuous-flow VAD implant, approximately one half of pediatric patients are already transplanted, whereas the vast majority (95%) of adult patients remain on VAD. 4 The reasons for such a notable difference are multifactorial. Children having better access to donor hearts is one of the reasons.…”

“…Taking these considerations in mind, we introduced a 3month waiting policy after continuous-flow VAD implant in 2012 at Texas Children's Hospital. 4 With this policy, patients are kept inactivated on the transplant wait-list (if already on the list) for at least 3 months, unless there are significant concerns with long-term VAD support. In our experience of>50 HVAD implants to date, most patients tolerate the waiting period well without major issues, as evidenced by a 1-year survival rate of 97%.…”