Starting Pediatric VAD Program: Transforming Challenges into Opportunities; A Case Series of a Single Center
DOI:
https://doi.org/10.59958/hsf.5545Keywords:
ventricular assist device, children, cardiomyopathy, thromboembolic events, case seriesAbstract
Background: The prevalence of heart failure is constantly increasing in both children and adults. End-stage heart failure in children unresponsive to medical therapy has limited treatment options. Surgical options include heart transplantation or implantation of durable ventricular assist devices (VADs). To start the VAD program, it was necessary to train core team members, invite experienced proctors and adjust the organizational approach. Methods: We present our first seven pediatric patients who underwent a VAD implantation with primary indication end-stage dilated cardiomyopathy. Results: The median age on implant was four and a half years and the median duration of VAD support was 39 days with long term survival achieved in three patients. The causes of death were multiorgan failure, thromboembolic events, sepsis, and low cardiac output syndrome. Ischemic stroke was the reason for successful neurointervention during VAD support in two patients. Conclusions: To establish a VAD program, numerous specialties must be included with adequate training and learning for all team members.
References
DeBakey ME. Left ventricular bypass pump for cardiac assistance. Clinical experience. The American Journal of Cardiology. 1971; 27: 3–11.
Warnecke H, Berdjis F, Hennig E, Lange P, Schmitt D, Hummel M, et al. Mechanical left ventricular support as a bridge to cardiac transplantation in childhood. European Journal of Cardio-Thoracic Surgery. 1991; 5: 330–333.
Javier Delmo EM, Javier MFDM, Hetzer R. The role of ventricular assist device in children. Cardiovascular Diagnosis and Therapy. 2021; 11: 193–201.
Mascio CE. The use of ventricular assist device support in children: the state of the art. Artificial Organs. 2015; 39: 14–20.
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. The Journal of Heart and Lung Transplantation. 2018; 37: 38–45.
Giorni C, Rizza A, Favia I, Amodeo A, Chiusolo F, Picardo SG, et al. Pediatric Mechanical Circulatory Support: Pathophysiology of Pediatric Hemostasis and Available Options. Frontiers in Cardiovascular Medicine. 2021; 8: 671241.
Almond CS, Buchholz H, Massicotte P, Ichord R, Rosenthal DN, Uzark K, et al. Berlin Heart EXCOR Pediatric ventricular assist device Investigational Device Exemption study: study design and rationale. American Heart Journal. 2011; 162: 425–435.e6.
Ghbeis MB, Vander Pluym CJ, Thiagarajan RR. Hemostatic Challenges in Pediatric Critical Care Medicine-Hemostatic Balance in VAD. Frontiers in Pediatrics. 2021; 9: 625632.
Taylor T, Campbell CT, Kelly B. A Review of Bivalirudin for Pediatric and Adult Mechanical Circulatory Support. American Journal of Cardiovascular Drugs. 2021; 21: 395–409.
Hetzer R, Kaufmann F, Delmo Walter EM. Paediatric mechanical circulatory support with Berlin Heart EXCOR: development and outcome of a 23-year experience. European Journal of Cardio-Thoracic Surgery. 2016; 50: 203–210.
Rockett SR, Bryant JC, Morrow WR, Frazier EA, Fiser WP, McKamie WA, et al. Preliminary single center North American experience with the Berlin Heart pediatric EXCOR device. ASAIO Journal. 2008; 54: 479–482.
Hetzer R, Potapov EV, Alexi-Meskishvili V, Weng Y, Miera O, Berger F, et al. Single-center experience with treatment of cardiogenic shock in children by pediatric ventricular assist devices. The Journal of Thoracic and Cardiovascular Surgery. 2011; 141: 616–623.e1.
Lichtenstein KM, Tunuguntla HP, Peng DM, Buchholz H, Conway J. Pediatric ventricular assist device registries: update and perspectives in the era of miniaturized continuous-flow pumps. Annals of Cardiothoracic Surgery. 2021; 10: 329–338.
Fraser CD, Jr, Jaquiss RDB. The Berlin Heart EXCOR Pediatric ventricular assist device: history, North American experience, and future directions. Annals of the New York Academy of Sciences. 2013; 1291: 96–105.
Rossano JW, VanderPluym CJ, Peng DM, Hollander SA, Maeda K, Adachi I, et al. Fifth Annual Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report. The Annals of Thoracic Surgery. 2021; 112: 1763–1774.
Hetzer R, Javier MFDM, Delmo Walter EM. Role of paediatric assist device in bridge to transplant. Annals of Cardiothoracic Surgery. 2018; 7: 82–98.
Rossano JW, Lorts A, VanderPluym CJ, Jeewa A, Guleserian KJ, Bleiweis MS, et al. Outcomes of pediatric patients supported with continuous-flow ventricular assist devices: A report from the Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS). The Journal of Heart and Lung Transplantation. 2016; 35: 585–590.
Sharma MS, Forbess JM, Guleserian KJ. Ventricular assist device support in children and adolescents with heart failure: the Children's Medical Center of Dallas experience. Artificial Organs. 2012; 36: 635–639.
Redondo A, Davies B, Jones R, O’Callaghan M, Kostolny M. Durable mechanical circulatory support in paediatric heart failure: The experience at Great Ormond Street Hospital. Cirugía Cardiovascular. 2019; 26: 30–34.
Javier Delmo EM, Javier MFDM, Böthig D, Rüffer A, Cesnjevar R, Dandel M, et al. Heart failure in the young: Insights into myocardial recovery with ventricular assist device support. Cardiovascular Diagnosis and Therapy. 2021; 11: 148–163.
Schweiger M, E Mascio C, Kanter KR, Marasco S, Eghtesady P, Miera O, et al. Intracorporeal Biventricular Assist Devices Using the Heartware Ventricular Assist Device in Children. ASAIO Journal. 2020; 66: 1031–1034.
O'Connor MJ, Lorts A, Davies RR, Fynn-Thompson F, Joong A, Maeda K, et al. Early experience with the HeartMate 3 continuous-flow ventricular assist device in pediatric patients and patients with congenital heart disease: A multicenter registry analysis. The Journal of Heart and Lung Transplantation. 2020; 39: 573–579.
Woods RK, Kindel S, Mitchell ME, Hraska V, Niebler RA. Evolving understanding of total artificial heart support of young infants and children. The Journal of Thoracic and Cardiovascular Surgery. 2020; 159: 1075–1082.
George AN, Hsia TY, Schievano S, Bozkurt S. Complications in children with ventricular assist devices: systematic review and meta-analyses. Heart Failure Reviews. 2022; 27: 903–913.
Beasley GS, Nelson-McMillan K, Vricella L, Thompson WR, Ravekes W. Direct Echocardiographic Imaging of Berlin Heart Valves Can Aid in Early Detection of Berlin Heart Valve Dysfunction. ASAIO Journal. 2019; 65: e4–e6.
Fatullayev J, Samak M, Sabashnikov A, Zeriouh M, Rahmanian PB, Choi YH, et al. Continuous-Flow Left Ventricular Assist Device Thrombosis: A Danger Foreseen is a Danger Avoided. Medical Science Monitor Basic Research. 2015; 21: 141–144.
Werho DK, Pasquali SK, Yu S, Donohue J, Annich GM, Thiagarajan RR, et al. Hemorrhagic complications in pediatric cardiac patients on extracorporeal membrane oxygenation: an analysis of the Extracorporeal Life Support Organization Registry. Pediatric Critical Care Medicine. 2015; 16: 276–288.
Fraser CD, Jr, Jaquiss RDB, Rosenthal DN, Humpl T, Canter CE, Blackstone EH, et al. Prospective trial of a pediatric ventricular assist device. The New England Journal of Medicine. 2012; 367: 532–541.
Rosenthal DN, Lancaster CA, McElhinney DB, Chen S, Stein M, Lin A, et al. Impact of a modified anti-thrombotic guideline on stroke in children supported with a pediatric ventricular assist device. The Journal of Heart and Lung Transplantation. 2017; 36: 1250–1257.
Byrnes JW, Prodhan P, Williams BA, Schmitz ML, Moss MM, Dyamenahalli U, et al. Incremental reduction in the incidence of stroke in children supported with the Berlin EXCOR ventricular assist device. The Annals of Thoracic Surgery. 2013; 96: 1727–1733.
Medar SS, Hsu DT, Lamour JM, Bansal N, Peek GJ. Use of bivalirudin as a primary anticoagulant in a child during Berlin Heart EXCOR ventricular assist device support. Perfusion. 2020; 35: 172–176.
Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. The New England Journal of Medicine. 2015; 372: 1019–1030.
Madaelil TP, Kansagra AP, Cross DT, Moran CJ, Derdeyn CP. Mechanical thrombectomy in pediatric acute ischemic stroke: Clinical outcomes and literature review. Interventional Neuroradiology. 2016; 22: 426–431.
Stowe RC, Kan P, Breen DB, Agarwal S. Mechanical thrombectomy for pediatric acute stroke and ventricular assist device. Brain & Development. 2018; 40: 81–84.
Wilson JL, Eriksson CO, Williams CN. Endovascular Therapy in Pediatric Stroke: Utilization, Patient Characteristics, and Outcomes. Pediatric Neurology. 2017; 69: 87–92.e2.
Satti S, Chen J, Sivapatham T, Jayaraman M, Orbach D. Mechanical thrombectomy for pediatric acute ischemic stroke: review of the literature. Journal of Neurointerventional Surgery. 2017; 9: 732–737.
Keihanian F, Saeidinia A, Bagheri RK, Johnston TP, Sahebkar A. Curcumin, hemostasis, thrombosis, and coagulation. Journal of Cellular Physiology. 2018; 233: 4497–4511.
Yuerek M, Kozyak BW, Shankar VR. Advances in Extracorporeal Support Technologies in Critically Ill Children. Indian Journal of Pediatrics. 2023; 90: 501–509.
Steffen RJ, Miletic KG, Schraufnagel DP, Vargo PR, Fukamachi K, Stewart RD, et al. Mechanical circulatory support in pediatrics. Expert Review of Medical Devices. 2016; 13: 507–514.
