Pediatric Ventricular Assist Device (VAD) as Successful Bridge to Heart Transplantation

Abstract

Introduction. Mechanical circulatory support (MCS) devices are a consolidate option for patients who are on the list for a transplant or dramatically unstable and an important tool for children who underwent cardiogenic shock, especially in the context of scarcity of donors and in which there has been an important increase in hospitalizations for pediatric heart failure. Case report. We present the case of a 1-year-old male infant presenting flu symptoms when he was 30 days old and with an evolving low cardiac output and cardiorespiratory arrest. He needed increased doses of vasoactive drugs and was diagnosed in our service with dilated cardiomyopathy, important left ventricular dysfunction of unknown etiology, left ventricular ejection fraction of 24%, mild right ventricular dysfunction, and septic/cardiogenic shock, and was listed for heart transplantation. A few days later, he had an important worsening of the hemodynamic parameters and was referred to our pediatric cardiovascular surgery team. He was evaluated for surgery, and ECMO was indicated as an emergency procedure. Eight days after, since he presented important pulmonary improvement, VAD implant was indicated as a bridge to transplantation; the infant then underwent a new surgery for implantation of a 10 mL left ventricular assistance device (Berlin Heart EXCOR®). Since he became hemodynamically stable, was extubated, and both his hepatic and kidney functions were normal, he was listed for transplantation again. After a good evaluation in the 11 months that followed, he finally underwent cardiac transplantation and is currently stable. Conclusion. MCS is an important alternative as a bridge to heart transplantation with a big potential to change the survival rates after the surgical procedure. The challenges for its pediatric use remain a relevant issue, mainly to developing countries such as Brazil, where the investment in education is the key to achieve similar results as the centers of excellence abroad.