Ventricular Assist Device Support in Children and Adolescents With Heart Failure

The Children's Medical Center of Dallas Experience

Mahesh S. Sharma*, Joseph M. Forbess, Kristine J. Guleserian

*Corresponding author for this work

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Children with heart failure unresponsive to medical therapy are left with few options for survival. Ventricular assist devices (VADs) are life-saving options for such patients, allowing for bridge to transplantation or cardiac recovery. Retrospective review of cases from May 2006 to October 2010 was undertaken. Fourteen patients underwent implantation of VADs for refractory heart failure. Mean age was 9 years (range 1-17 years), and weight was 41kg (range 9.7-71kg). Indications for support: end-stage cardiomyopathy (n=8), myocarditis (n=3), univentricular failure (n=2), and congenital heart disease/postcardiotomy (n=1). Level of limitation at time of implant included critical cardiogenic shock in six (43%) and progressive decline in eight (57%). Extracorporeal membrane oxygenation was used as a bridge to VAD in five (36%) patients. Preimplant variables: 86% of patients requiring mechanical ventilation (mean 10.3 days), hyperbilirubinemia in 75%, and acute renal insufficiency in 79%. Device selection was systemic VAD in 11 (79%) and biventricular assist device in three (21%). Berlin Heart EXCOR was used in eight patients, while six patients received a Thoratec implantable VAD or paracorporeal VAD. Mean duration of support was 68 days (range 8-363 days). Overall survival was 79%. Ten patients (71%) were successfully bridged to transplantation, three (21%) died while on a device, one remains on support, and no patients were weaned from VAD. Children supported for single ventricle heart failure had a 50% survival with none currently bridged to transplantation. Complications included bleeding requiring reoperation in 21% (n=3), stroke in 29% (n=4), and driveline infections in 7% (n=1). In two patients, a total of six pump exchanges were performed for thrombus formation. Survival for pediatric patients of all ages is excellent using current device technology with a majority of patients being successfully bridged to transplantation. Morbidity is acceptably low considering the severity of illness. Significant challenges exist with long-term extracorporeal support due to lack of donor availability and the high incidence of preformed alloantibodies especially in the failing single ventricle.

Original languageEnglish (US)
Pages (from-to)635-639
Number of pages5
JournalArtificial Organs
Volume36
Issue number7
DOIs
StatePublished - Jul 1 2012

Fingerprint

Heart-Assist Devices
Heart Failure
Isoantibodies
Pediatrics
Oxygenation
Equipment and Supplies
Survival
Transplantation
Refractory materials
Availability
Pumps
Membranes
Recovery
Extracorporeal Membrane Oxygenation
Hyperbilirubinemia
Cardiogenic Shock
Myocarditis
Berlin
Heart Transplantation
Cardiomyopathies

Keywords

  • Heart failure
  • Pediatric
  • Single ventricle
  • Ventricular assist device

ASJC Scopus subject areas

  • Biomaterials
  • Biomedical Engineering
  • Bioengineering
  • Medicine (miscellaneous)

Cite this

@article{0bea818509ed4635a6145140f3f29fd5,
title = "Ventricular Assist Device Support in Children and Adolescents With Heart Failure: The Children's Medical Center of Dallas Experience",
abstract = "Children with heart failure unresponsive to medical therapy are left with few options for survival. Ventricular assist devices (VADs) are life-saving options for such patients, allowing for bridge to transplantation or cardiac recovery. Retrospective review of cases from May 2006 to October 2010 was undertaken. Fourteen patients underwent implantation of VADs for refractory heart failure. Mean age was 9 years (range 1-17 years), and weight was 41kg (range 9.7-71kg). Indications for support: end-stage cardiomyopathy (n=8), myocarditis (n=3), univentricular failure (n=2), and congenital heart disease/postcardiotomy (n=1). Level of limitation at time of implant included critical cardiogenic shock in six (43{\%}) and progressive decline in eight (57{\%}). Extracorporeal membrane oxygenation was used as a bridge to VAD in five (36{\%}) patients. Preimplant variables: 86{\%} of patients requiring mechanical ventilation (mean 10.3 days), hyperbilirubinemia in 75{\%}, and acute renal insufficiency in 79{\%}. Device selection was systemic VAD in 11 (79{\%}) and biventricular assist device in three (21{\%}). Berlin Heart EXCOR was used in eight patients, while six patients received a Thoratec implantable VAD or paracorporeal VAD. Mean duration of support was 68 days (range 8-363 days). Overall survival was 79{\%}. Ten patients (71{\%}) were successfully bridged to transplantation, three (21{\%}) died while on a device, one remains on support, and no patients were weaned from VAD. Children supported for single ventricle heart failure had a 50{\%} survival with none currently bridged to transplantation. Complications included bleeding requiring reoperation in 21{\%} (n=3), stroke in 29{\%} (n=4), and driveline infections in 7{\%} (n=1). In two patients, a total of six pump exchanges were performed for thrombus formation. Survival for pediatric patients of all ages is excellent using current device technology with a majority of patients being successfully bridged to transplantation. Morbidity is acceptably low considering the severity of illness. Significant challenges exist with long-term extracorporeal support due to lack of donor availability and the high incidence of preformed alloantibodies especially in the failing single ventricle.",
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Ventricular Assist Device Support in Children and Adolescents With Heart Failure : The Children's Medical Center of Dallas Experience. / Sharma, Mahesh S.; Forbess, Joseph M.; Guleserian, Kristine J.

In: Artificial Organs, Vol. 36, No. 7, 01.07.2012, p. 635-639.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Ventricular Assist Device Support in Children and Adolescents With Heart Failure

T2 - The Children's Medical Center of Dallas Experience

AU - Sharma, Mahesh S.

AU - Forbess, Joseph M.

AU - Guleserian, Kristine J.

PY - 2012/7/1

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N2 - Children with heart failure unresponsive to medical therapy are left with few options for survival. Ventricular assist devices (VADs) are life-saving options for such patients, allowing for bridge to transplantation or cardiac recovery. Retrospective review of cases from May 2006 to October 2010 was undertaken. Fourteen patients underwent implantation of VADs for refractory heart failure. Mean age was 9 years (range 1-17 years), and weight was 41kg (range 9.7-71kg). Indications for support: end-stage cardiomyopathy (n=8), myocarditis (n=3), univentricular failure (n=2), and congenital heart disease/postcardiotomy (n=1). Level of limitation at time of implant included critical cardiogenic shock in six (43%) and progressive decline in eight (57%). Extracorporeal membrane oxygenation was used as a bridge to VAD in five (36%) patients. Preimplant variables: 86% of patients requiring mechanical ventilation (mean 10.3 days), hyperbilirubinemia in 75%, and acute renal insufficiency in 79%. Device selection was systemic VAD in 11 (79%) and biventricular assist device in three (21%). Berlin Heart EXCOR was used in eight patients, while six patients received a Thoratec implantable VAD or paracorporeal VAD. Mean duration of support was 68 days (range 8-363 days). Overall survival was 79%. Ten patients (71%) were successfully bridged to transplantation, three (21%) died while on a device, one remains on support, and no patients were weaned from VAD. Children supported for single ventricle heart failure had a 50% survival with none currently bridged to transplantation. Complications included bleeding requiring reoperation in 21% (n=3), stroke in 29% (n=4), and driveline infections in 7% (n=1). In two patients, a total of six pump exchanges were performed for thrombus formation. Survival for pediatric patients of all ages is excellent using current device technology with a majority of patients being successfully bridged to transplantation. Morbidity is acceptably low considering the severity of illness. Significant challenges exist with long-term extracorporeal support due to lack of donor availability and the high incidence of preformed alloantibodies especially in the failing single ventricle.

AB - Children with heart failure unresponsive to medical therapy are left with few options for survival. Ventricular assist devices (VADs) are life-saving options for such patients, allowing for bridge to transplantation or cardiac recovery. Retrospective review of cases from May 2006 to October 2010 was undertaken. Fourteen patients underwent implantation of VADs for refractory heart failure. Mean age was 9 years (range 1-17 years), and weight was 41kg (range 9.7-71kg). Indications for support: end-stage cardiomyopathy (n=8), myocarditis (n=3), univentricular failure (n=2), and congenital heart disease/postcardiotomy (n=1). Level of limitation at time of implant included critical cardiogenic shock in six (43%) and progressive decline in eight (57%). Extracorporeal membrane oxygenation was used as a bridge to VAD in five (36%) patients. Preimplant variables: 86% of patients requiring mechanical ventilation (mean 10.3 days), hyperbilirubinemia in 75%, and acute renal insufficiency in 79%. Device selection was systemic VAD in 11 (79%) and biventricular assist device in three (21%). Berlin Heart EXCOR was used in eight patients, while six patients received a Thoratec implantable VAD or paracorporeal VAD. Mean duration of support was 68 days (range 8-363 days). Overall survival was 79%. Ten patients (71%) were successfully bridged to transplantation, three (21%) died while on a device, one remains on support, and no patients were weaned from VAD. Children supported for single ventricle heart failure had a 50% survival with none currently bridged to transplantation. Complications included bleeding requiring reoperation in 21% (n=3), stroke in 29% (n=4), and driveline infections in 7% (n=1). In two patients, a total of six pump exchanges were performed for thrombus formation. Survival for pediatric patients of all ages is excellent using current device technology with a majority of patients being successfully bridged to transplantation. Morbidity is acceptably low considering the severity of illness. Significant challenges exist with long-term extracorporeal support due to lack of donor availability and the high incidence of preformed alloantibodies especially in the failing single ventricle.

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