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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)
  • 40 Downloads

Abstract

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.

Keywords

Ventricular assist device-pediatric Implantable VAD Paracorporeal VAD Transplantation 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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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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