Pediatric ventricular assist device therapy for advanced heart failure-Hong Kong experience

  • Inderjeet BhatiaEmail author
  • Ka-Lai Cally Ho
  • Barnabe Antonio Rocha
  • Nicholson Yam
  • Kin-Shing Lun
  • Tak-Cheung Yung
  • Wing-Kuk Timmy AuEmail author
Original Article Artificial Heart (Clinical)


Ventricular assist devices (VADs) are life-saving options for children with heart failure unresponsive to medical therapy as a bridge to transplantation or cardiac recovery. We present a retrospective review of 13 consecutive children who underwent implantation of VAD between 2001 and 2018 in our center. The median age was 12 years (1–17 years), weight was 45 kg (10–82 kg). Etiologies of heart failure were dilated cardiomyopathy (CMP) (n = 8), myocarditis (n = 2), ischemic CMP (n = 1), restrictive CMP (n = 1) and congenital heart disease (n = 1). Pre-implantation ECMO was used in 5, mechanical ventilation in 4, renal replacement therapy in 2 and IABP in 1. Devices used were: Berlin Heart EXCOR left VAD (LVAD), biventricular VAD (BIVAD) (n = 5, 2), CentriMag LVAD, BIVAD (n = 1, 2), HeartWare (n = 2), HeartMate II (n = 1). Median duration of support was 45 days (3–823 days). Overall survival was 85%. Four patients were successfully bridged to transplantation, 2 died while on a device, 4 remain on support and 3 were weaned from VAD. Late death occurred in 2 transplanted patients. Complications included bleeding requiring reoperation in 1, neurologic events in 3, driveline infections and pericardial effusion in 2 each. In one patient, CentriMag BIVAD provided support for 235 days, which is longest reported duration on such a VAD in the Asia Pacific region. Survival for pediatric patients of all ages is excellent using VADs. Given the severity of illness in these children morbidity and mortality is acceptable. VADs could potentially be used as a long-term bridge to transplantation in view of the donor shortage in the pediatric population.


Ventricular assist device-pediatric Implantable VAD Paracorporeal VAD Transplantation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Sivathasan C, Lim CP, Kerk KL, Sim DK, Mehra MR. Mechanical circulatory support and heart transplantation in the Asia Pacific region. J Heart Lung Transplant. 2017;36:13–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Dipchand AI. Current state of pediatric cardiac transplantation. Ann Cardiothorac Surg. 2018;7:31–55.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Jeewa A, Manlhiot C, McCrindle BW, Van Arsdell G, Humpl T, Dipchand AI. Outcomes with ventricular assist device versus extracorporeal membrane oxygenation as a bridge to pediatric heart transplantation. Artif Org. 2010;34:1087–91.CrossRefGoogle Scholar
  4. 4.
    Zafar F, Castleberry C, Khan MS, Mehta V, Bryant R 3rd, Lorts A, et al. Pediatric heart transplant waiting list mortality in the era of ventricular assist devices. J Heart Lung Transplant. 2015;34:82–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Hollander SA, Schultz LM, Dennis K, Hollander AM, Rizzuto S, Murray JM, et al. Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation. Pediatr Transplant. 2019;23:e13351.CrossRefPubMedGoogle Scholar
  6. 6.
    Morales DLS, Rossano JW, VanderPluym C, Lorts A, Cantor R, St Louis JD, et al. Third annual pediatric interagency registry for mechanical circulatory support (pedimacs) report: preimplant characteristics and outcomes. Ann Thorac Surg. 2019;107:993–1004.CrossRefPubMedGoogle Scholar
  7. 7.
    Conway J, Miera O, Adachi I, Maeda K, Eghtesady P, Henderson HT, et al. Worldwide experience of a durable centrifugal flow pump in pediatric patients. Semin Thorac Cardiovasc Surg. 2018;30:327–35.CrossRefPubMedGoogle Scholar
  8. 8.
    Adachi I, Guzman-Pruneda FA, Jeewa A, Fraser CD Jr, Dean McKenzie E. A modified implantation technique of the HeartWare ventricular assist device for pediatric patients. J Heart Lung Transplant. 2015;34:134–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Cabrera AG, Sundareswaran KS, Samayoa AX, Jeewa A, McKenzie ED, Rossano JW, et al. Outcomes of pediatric patients supported by the HeartMate II left ventricular assist device in the United States. J Heart Lung Transplant. 2013;32:1107–13.CrossRefPubMedGoogle Scholar
  10. 10.
    Miera O, Kirk R, Buchholz H, Schmitt KR, VanderPluym C, Rebeyka IM, et al. A multicenter study of the HeartWare ventricular assist device in small children. J Heart Lung Transplant. 2016;35:679–81.CrossRefPubMedGoogle Scholar
  11. 11.
    Miera O, Potapov EV, Redlin M, Stepanenko A, Berger F, Hetzer R, et al. First experiences with the HeartWare ventricular assist system in children. Ann Thorac Surg. 2011;91:1256–60.CrossRefPubMedGoogle Scholar
  12. 12.
    Padalino MA, Bottio T, Tarzia V, Bortolussi G, Cerutti A, Vida VL, et al. HeartWare ventricular assist device as bridge to transplant in children and adolescents. Artif Org. 2014;38:418–22.CrossRefGoogle Scholar
  13. 13.
    Schweiger M, Vanderpluym C, Jeewa A, Canter CE, Jansz P, Parrino PE, et al. Outpatient management of intra-corporeal left ventricular assist device system in children: a multi-center experience. Am J Transplant. 2015;15:453–60.CrossRefPubMedGoogle Scholar
  14. 14.
    Hetzer R, Javier M, Delmo Walter EM. Role of paediatric assist device in bridge to transplant. Ann Cardiothorac Surg. 2018;7:82–988.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Chen JM, Richmond ME, Charette K, Takayama H, Williams M, Gilmore L, et al. A decade of pediatric mechanical circulatory support before and after cardiac transplantation. J Thorac Cardiovasc Surg. 2012;143:344–51.CrossRefPubMedGoogle Scholar
  16. 16.
    Davies RR, Haldeman S, McCulloch MA, Pizarro C. Ventricular assist devices as a bridge-to-transplant improve early post-transplant outcomes in children. J Heart Lung Transplant. 2014;33:704–12.CrossRefPubMedGoogle Scholar
  17. 17.
    De Rita F, Hasan A, Haynes S, Peng E, Gandolfo F, Ferguson L, et al. Outcome of mechanical cardiac support in children using more than one modality as a bridge to heart transplantation. Eur J Cardiothorac Surg. 2015;48:917–22; discussion 22.Google Scholar
  18. 18.
    Kindel SJ, Everitt MD. A contemporary review of paediatric heart transplantation and mechanical circulatory support. Cardiol Young. 2016;26:851–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Lorts A, Blume ED. Pediatric mechanical circulatory support: available devices and outcomes as bridge-to-transplant therapy. Curr Opin Org Transplant. 2015;20:557–61.CrossRefGoogle Scholar
  20. 20.
    Miller JR, Eghtesady P. Ventricular assist device use in congenital heart disease with a comparison to heart transplant. J Comp Eff Res. 2014;3:533–46.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Sharma MS, Webber SA, Morell VO, Gandhi SK, Wearden PD, Buchanan JR, et al. Ventricular assist device support in children and adolescents as a bridge to heart transplantation. Ann Thorac Surg. 2006;82:926–32.CrossRefPubMedGoogle Scholar
  22. 22.
    Wehman B, Stafford KA, Bittle GJ, Kon ZN, Evans CF, Rajagopal K, et al. Modern outcomes of mechanical circulatory support as a bridge to pediatric heart transplantation. Ann Thorac Surg. 2016;101:2321–7.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Morales DL, Almond CS, Jaquiss RD, Rosenthal DN, Naftel DC, Massicotte MP, et al. Bridging children of all sizes to cardiac transplantation: the initial multicenter North American experience with the Berlin Heart EXCOR ventricular assist device. J Heart Lung Transplant. 2011;30:1–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Holman WL, Kormos RL, Naftel DC, Miller MA, Pagani FD, Blume E, et al. Predictors of death and transplant in patients with a mechanical circulatory support device: a multi-institutional study. J Heart Lung Transplant. 2009;28:44–50.CrossRefPubMedGoogle Scholar
  25. 25.
    Rohde S, Antonides CFJ, Dalinghaus M, Muslem R, Bogers A. Clinical outcomes of paediatric patients supported by the Berlin Heart EXCOR: a systematic review. Eur J Cardiothorac Surg. 2019. Scholar
  26. 26.
    Miller JR, Epstein DJ, Henn MC, Guthrie T, Schuessler RB, Simpson KE, et al. Early biventricular assist device use in children: a single-center review of 31 patients. Asaio j. 2015;61:688–94.CrossRefPubMedGoogle Scholar
  27. 27.
    Yarlagadda VV, Maeda K, Zhang Y, Chen S, Dykes JC, Gowen MA, et al. Temporary circulatory support in U.S. children awaiting heart transplantation. J Am Coll Cardiol. 2017;70:2250–60.CrossRefPubMedGoogle Scholar
  28. 28.
    Blume ED, VanderPluym C, Lorts A, Baldwin JT, Rossano JW, Morales DLS, et al. Second annual pediatric interagency registry for mechanical circulatory support (Pedimacs) report: pre-implant characteristics and outcomes. J Heart Lung Transplant. 2018;37:38–45.CrossRefPubMedGoogle Scholar
  29. 29.
    Pac M, Kocabeyoglu SS, Kervan U, Sert DE, Koca S, Ece I, et al. Third generation ventricular assist device: mid-term outcomes of the HeartWare HVAD in pediatric patients. Artif Org. 2018;42:141–7.CrossRefGoogle Scholar
  30. 30.
    Pretre R, Haussler A, Bettex D, Genoni M. Right-sided univentricular cardiac assistance in a failing Fontan circulation. Ann Thorac Surg. 2008;86:1018–20.CrossRefPubMedGoogle Scholar
  31. 31.
    Lorts A, Eghtesady P, Mehegan M, Adachi I, Villa C, Davies R, et al. Outcomes of children supported with devices labeled as "temporary" or short term: a report from the Pediatric Interagency Registry for Mechanical Circulatory Support. J Heart Lung Transplant. 2018;37:54–60.CrossRefPubMedGoogle Scholar
  32. 32.
    Arnaoutakis GJ, George TJ, Kilic A, Weiss ES, Russell SD, Conte JV, et al. Effect of sensitization in US heart transplant recipients bridged with a ventricular assist device: update in a modern cohort. J Thorac Cardiovasc Surg. 2011;142:1236–45, 45.e1.Google Scholar
  33. 33.
    Malickaite R, Rucinskas K, Staneviciene A, Miniauskas S, Maneikiene V, Zuoziene G, et al. Sensitisation and post-transplant course after the implantation of ventricular assist device. Interact Cardiovasc Thorac Surg. 2009;8:339–42; discussion 42–3.CrossRefPubMedGoogle Scholar
  34. 34.
    Rossano JW, Cherikh WS, Chambers DC, Goldfarb S, Hayes D Jr, Khush KK, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: twenty-first pediatric heart transplantation report-2018; Focus theme: Multiorgan Transplantation. J Heart Lung Transplant. 2018;37:1184–95.CrossRefPubMedGoogle Scholar
  35. 35.
    Rosenthal DN, Almond CS, Jaquiss RD, Peyton CE, Auerbach SR, Morales DR, et al. Adverse events in children implanted with ventricular assist devices in the United States: data from the Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS). J Heart Lung Transplant. 2016;35:569–77.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    "Action Learning Network". Action Learning Network. 2018.

Copyright information

© The Japanese Society for Artificial Organs 2019

Authors and Affiliations

  1. 1.Department of Cardiothoracic SurgeryQueen Mary HospitalHong KongChina
  2. 2.Department of Paediatric CardiologyQueen Mary HospitalHong KongChina

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