Current Clinical Status of Pulsatile Pediatric Circulatory Support

Abstract

Whereas circulatory support with pulsatile assist devices is an established therapy in adults today, it remains unusual and extremely challenging in children. Specifically designed smaller size pumps are, to date, only available in Europe. This review summarizes the experience with both adult size pumps in the U.S. and pediatric pumps in Europe. Thoratec ventricular assist devices (VADs) were implanted in 101 patients worldwide who were between 7 and 17 years of age. Survival in this group was 68.8%, which is comparable with that in adult patients and was independent of age or body size. Berlin Heart VADs, available in several sizes, were implanted at the Deutsches Herzzentrum Berlin in 45 patients between 2 days and 16 years old. Survival in patients with myocarditis and cardiomyopathy was 66.7% and 71.4%, respectively; overall survival was 48.9%. In a number of European centers, 64 children up to 16 years of age received Medos devices, which are also available in several sizes, with an overall survival of 36.2%, similar for all pump sizes. End-stage congenital heart defects or failure to wean off bypass carried a poorer prognosis than cardiomyopathies or myocarditis for all devices.

Pneumatic Paracorporeal Ventricular Assist Device in Infants and Children: Initial Stanford Experience

“…In a worldwide review of 109 pediatric patients ranging from 2 days to 16 years of age, Reinhartz and colleagues showed a survival to transplantation of 49% for the Berlin Heart VAD and 36% for the Medos VAD. 17 Experience in the USA, where these devices are implanted on a compassionate-use basis, remains preliminary. 14 In a review of 5 pediatric patients from 1 to 9 years of age, supported with either the Berlin Heart or Medos VAD, Arabia and colleagues reported survival to transplantation in 3 patients.…”

Extended survival and re-hospitalisation among paediatric patients requiring extracorporeal membrane oxygenation for primary cardiac dysfunction

“…21 The survival rate to hospital discharge for paediatric patients requiring extracorporeal membrane oxygenation for myocardial dysfunction at our centre falls within the range reported in previous studies. [20][21][22][23][24][25][26][27] Certainly survival to hospital discharge for these patients is heavily influenced by the pathophysiology that determined their being placed on extracorporeal membrane oxygenation. It is indeed variable: higher for paediatric patients with myocarditis and more guarded after cardiac surgery and in cases of primary graft failure after orthotopic heart transplant.…”

Ventricular Assist Devices for Pediatric Heart Disease

“…They can be applied especially on patients who will undergo heart transplantation following anomalous origin of the left coronary artery from the pulmonary artery repair or late arterial switch operation and secondary pulmonary hypertension in right heart failure (Del Nido et al, 1999). Discharge survival rate in two studies supported by peroperative centrifugal VAD is around 40 % and have similarities with the usage of ECMO (Duncan et al, 1999;Thuys et al, 1998 (Merkle et al, 2003;Reinhartz et al, 2002). Thoratec paracorporeal assist devices can be used successfully for adult patients and child patients over 10 years of age, as well (Reinhartz et al, 2001).…”

“…Several series have been published describing use of the MEDOS system for pediatric support. Reinhartz reported 64 children supported with the MEDOS HIAVAD, 44 % of whom were supported with the smallest pump sizes with an overall survival of 38 % for patients with available follow-up (Reinhartz et al, 2002). The Berlin Heart VAD has fewer bleeding complications compared to ECMO with decreased blood product utilization during support (Stillert et al, 2004).…”