Third Generation Ventricular Assist Device: Mid‐Term Outcomes of the HeartWare HVAD in Pediatric Patients

Abstract

The HeartWare HVAD is a small, third generation continuous flow pump that is intracorporeally placed for support of a failing ventricle in adult patients. This device is small in size when compared to other left ventricular assist devices and can therefore be used in smaller sized pediatric patients. We present our initial experience using the HVAD as a bridge to heart transplantation in the pediatric population. We performed a retrospective, single center, nonrandomized review of 17 pediatric patients who underwent HVAD implantation between June 2013 and March 2016. The primary endpoints evaluated in this study were overall survival to heart transplantation, ongoing device support, or death. In this patient cohort, nine (53%) of 17 patients were male. The median age of the patients was 13.4 ± 3.8 (range 5-17) years. The median body surface area was 1.4 ± 0.4(0.7-2) m . Etiologies of heart failure requiring HVAD support were dilated cardiomyopathy (n = 8), myocarditis (n = 5) and noncompaction cardiomyopathy (n = 4). The overall mean length of HVAD support was 254 ± 298 (range 2-804) days. A successful outcome (bridge to transplant and ongoing mechanical support) was achieved in 13 patients (76.5%). Of the 13 patients, nine (69.2%) were bridged to heart transplantation and four continue to receive support (30.7%) and are eligible for transplantation. Post-transplant survival has been 100%, with a mean follow-up of 296 ± 264.5 (range 18-785) days. The most common complication was pump thrombosis (23.5%) in follow-up. Four patients (23.5%) experienced no complications. The HVAD continuous flow ventricular assist device can be safely used to bridge pediatric patients to cardiac transplantation. Favorable outcomes of this device are comparable to the adult population. This analysis demonstrated safe and effective implantation of the HVAD System in a child with a BSA of 0.7 m .

HeartWare Ventricular Assist Device Implantation for Pediatric Heart Failure—A Single Center Approach

“…Use of continuous flow VADs is increasing in the pediatric population, improving quality of life and decreasing wait list mortality (1,13,(17)(18)(19)(20)(21)(22)(23). Survival in this cohort was quite high and other groups have reported survival in pediatric patients comparable to the adult population supported by this device, including support of pediatric patients for over two years (21,23). However, pediatric patients pose unique challenges to VAD use, given the variability in indications and size of patients.…”

Cerebrovascular events in children on intracorporeal continuous‐flow left ventricular assist devices

“…As these devices are being used in children to prevent death while waiting a transplant, acceptable rates of adverse effects are not the only plausible reason. Significant advantage of CF‐LVADs is that the majority of patients can be discharged home and be able to return back to their daily life with their caregivers 12 . Low rates of adverse events and opportunity to live outside the hospital give these children a chance to avoid hospital acquired infections, have psychological support by their family, and have better physical condition provided by good rehabilitation, ultimately leading to a favorable health at the time of transplant.…”

Artificial Organs 2018: A Year in Review

“…Mustafa Pac et al of the Turkey, Yuksek Ihtisas Hospital, Ankara, Turkey, reported on their initial experiences with the third generation continuous flow pump, HeartWare HVAD, as a bridge to heart transplantation in17 pediatric patients. A successful outcome was achieved in 13 patients.…”