Centrifugal-flow ventricular assist device support in children: A single-center experience

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 157; no. 4; pp. 1609 - 1617.e2
• Main Authors: Adachi, Iki, Zea-Vera, Rodrigo, Tunuguntla, Hari, Denfield, Susan W., Elias, Barbara, John, Rija, Teruya, Jun, Fraser, Charles D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2019
• Subjects: Adolescent; Age Factors; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - mortality; Cardiomyopathies - physiopathology; Cardiomyopathies - therapy; Child; Child, Preschool; Device Removal; Female; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - mortality; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - therapy; heart failure; Heart-Assist Devices; Humans; Male; mechanical circulatory support; outcomes; Prospective Studies; Prosthesis Design; Prosthesis Implantation - adverse effects; Prosthesis Implantation - instrumentation; Prosthesis Implantation - mortality; Recovery of Function; Texas; Time Factors; Treatment Outcome; Ventricular Function, Left; Texas; INTERMACS; heart failure; BSA; outcomes; mechanical circulatory support; VAD; LV; CF-VAD; PediMACS; CHD
• DOI: 10.1016/j.jtcvs.2018.12.045
• ISSN: 0022-5223

Our institutional policy is to continue centrifugal-flow ventricular assist device support for 3 months or more without activation on the transplant wait-list for physical recovery and assessment of possible myocardial recovery. We evaluated our single-institutional outcomes with centrifugal-flow ventricular assist device support in children. Prospectively collected outcomes data in consecutive patients aged 18 years or less with centrifugal-flow ventricular assist device support were reviewed. There were 40 implantations in 39 patients (28 with cardiomyopathy, 11 with congenital heart disease, including 3 with univentricular physiology). The median support was 8 months (range, 1-79), with 13 patients (33%) supported for 12 months or more and a cumulative duration of 41 patient-years. The median age and weight at implantation were 11 (4-18) years and 35 (14-98) kg, respectively. The median body surface area was 1.1 (0.7-2.2) m2, with 16 patients (40%) having a body surface area less than 1.0 m2. Thirty-four patients (85%) had Interagency Registry for Mechanically Assisted Circulatory Support 1 or 2. Children with congenital heart disease were significantly smaller (P < .01) and had more prior cardiac interventions (P < .01) than those with cardiomyopathy. There were 2 early mortalities (5%) in children with cardiomyopathy. Of the 38 patients with successful implantations, 36 (95%) were discharged home and managed as outpatients. Overall adverse event rates were 5.1 (bleeding), 0.8 (device malfunction), 6.1 (infection), 3.9 (neurologic dysfunction), and 1.0 (renal dysfunction) (per 100 patient-month). In the 21 patients with cardiomyopathy supported for 3 months or more, 5 (24%) experienced normalization of left ventricular function; 4 underwent successful explantation, and 1 remains on support. This study demonstrates favorable outcomes of centrifugal-flow ventricular assist device support in children, including those with congenital heart disease, with an increased incidence of cardiac recovery.