Right heart failure considerations in pediatric ventricular assist devices

Abstract

Right heart failure (RHF) is a vexing problem in children after left ventricular assist device (LVAD) implantation that can negatively impact transplant candidacy and survival. Anticipation, prevention, early identification and appropriate medical and device management of RHF are important to successful LVAD outcomes. However, there is limited pediatric evidence to guide practice. This pediatric-focused review summarizes the relevant literature and describes the harmonized approach to RHF from the Advanced Cardiac Therapies Improving Outcomes Network (ACTION). This review seeks to improve RHF outcomes through the sharing of best practices and experience across the pediatric VAD community.

Self‐reported quality of life in children with ventricular assist devices

“…Right heart failure is directly correlated with more critical pre-implant status and often results in refractory heart failure symptoms, end-organ dysfunction, and higher mortality which all may directly impact QOL. 24,25 There were more outpatients (compared with inpatients) with normal PedsQL scores at 3 months; however, this association did not reach statistical significance. This result, along with other negative findings, may reflect the low numbers and insufficient power to detect differences.…”

“…This was not completely unexpected as prolonged use of inotropes after VAD implant is generally for right heart failure or may reflect suboptimal circulatory support. Right heart failure is directly correlated with more critical pre‐implant status and often results in refractory heart failure symptoms, end‐organ dysfunction, and higher mortality which all may directly impact QOL 24,25 . There were more outpatients (compared with inpatients) with normal PedsQL scores at 3 months; however, this association did not reach statistical significance.…”

Arrhythmia Management in Pediatric Patients with Ventricular Assist Devices

“…However, pediatric patients are unique and must be treated in a case-by-case basis. Maintaining sinus rhythm is clearly advantageous in the biventricular heart and can help avoid right heart failure [60]. However, in this era where fewer than 50% of pediatric patients are discharged with a VAD, one must ask how aggressively to treat these arrhythmias, especially when it comes to implanting an ICD [61].…”