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Hetzer R, Javier MFDM, Javier Delmo EM. Pediatric ventricular assist devices: what are the key considerations and requirements? Expert Rev Med Devices 2019; 17:57-74. [PMID: 31779486 DOI: 10.1080/17434440.2020.1699404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The development of ventricular assist devices (VADs) have enabled myocardial recovery and improved patient survival until heart transplantation. However, device options remain limited for children and lag in development.Areas covered: This review focuses on the evolution of pediatric VADs in becoming to be an accepted treatment option in advanced heart failure, discusses the classification of VADs available for children, i.e. types of pumps and duration of support, and defines implantation indications and explantation criteria, describes attendant complications and long-term outcome of VAD support. Furthermore, we emphasize the key considerations and requirements in the application of these devices in infants, children and adolescents.Expert opinion: Increasing use of VADs has facilitated a leading edge in management of advanced heart failure either as a bridge to transplantation or as a bridge to myocardial recovery. In newborns and small children, the EXCOR Pediatric VAD remains the only reliable option. In some patients ventricular unloading may lead to complete myocardial recovery. There is a strong need for pumps that are fully implantable, suitable for single ventricle physiology, such as the right ventricle.
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Affiliation(s)
- Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
| | | | - Eva Maria Javier Delmo
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
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Ono M, Sawa Y, Nakatani T, Tominaga R, Matsui Y, Yamazaki K, Saiki Y, Niinami H, Matsumiya G, Arai H. Japanese Multicenter Outcomes With the HeartMate II Left Ventricular Assist Device in Patients With Small Body Surface Area. Circ J 2016; 80:1931-1936. [DOI: 10.1253/circj.cj-16-0203] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University
| | - Takeshi Nakatani
- Department of Transplantation, National Cardiovascular Research Center
| | | | - Yoshiro Matsui
- Department of Cardiovascular Surgery, Hokkaido University
| | - Kenji Yamazaki
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | | | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Saitama Medical University
| | | | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
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Almond CSD, Thiagarajan RR, Piercey GE, Gauvreau K, Blume ED, Bastardi HJ, Fynn-Thompson F, Singh TP. Waiting list mortality among children listed for heart transplantation in the United States. Circulation 2009; 119:717-727. [PMID: 19171850 DOI: 10.1161/circulationaha.108.815712] [Citation(s) in RCA: 269] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children listed for heart transplantation face the highest waiting list mortality in solid-organ transplantation medicine. We examined waiting list mortality since the pediatric heart allocation system was revised in 1999 to determine whether the revised allocation system is prioritizing patients optimally and to identify specific high-risk populations that may benefit from emerging pediatric cardiac assist devices. METHODS AND RESULTS We conducted a multicenter cohort study using the US Scientific Registry of Transplant Recipients. All children <18 years of age who were listed for a heart transplant between 1999 and 2006 were included. Among 3098 children, the median age was 2 years (interquartile range 0.3 to 12 years), and median weight was 12.3 kg (interquartile range 5 to 38 kg); 1294 (42%) were nonwhite; and 1874 (60%) were listed as status 1A (of whom 30% were ventilated and 18% were on extracorporeal membrane oxygenation). Overall, 533 (17%) died, 1943 (63%) received transplants, and 252 (8%) recovered; 370 (12%) remained listed. Multivariate predictors of waiting list mortality include extracorporeal membrane oxygenation support (hazard ratio [HR] 3.1, 95% confidence interval [CI] 2.4 to 3.9), ventilator support (HR 1.9, 95% CI 1.6 to 2.4), listing status 1A (HR 2.2, 95% CI 1.7 to 2.7), congenital heart disease (HR 2.2, 95% CI 1.8 to 2.6), dialysis support (HR 1.9, 95% CI 1.2 to 3.0), and nonwhite race/ethnicity (HR 1.7, 95% CI 1.4 to 2.0). CONCLUSIONS US waiting list mortality for pediatric heart transplantation remains unacceptably high in the current era. Specific high-risk subgroups can be identified that may benefit from emerging pediatric cardiac assist technologies. The current pediatric heart-allocation system captures medical urgency poorly. Further research is needed to define the optimal organ-allocation system for pediatric heart transplantation.
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Affiliation(s)
- Christopher S D Almond
- Department of Cardiology (C.S.D.A., R.R.T., G.E.P., K.G., E.D.B., H.J.B., T.P.S.), Cardiac Surgery (F.F.T.), and the Pediatric Transplant Center (C.S.D.A., E.D.B., H.J.B., F.F.T., T.P.S.), Children's Hospital Boston; the Department of Pediatrics, Harvard Medical School; and the Department of Biostatistics (K.G.), Harvard School of Public Health; all in Boston, Mass
| | - Ravi R Thiagarajan
- Department of Cardiology (C.S.D.A., R.R.T., G.E.P., K.G., E.D.B., H.J.B., T.P.S.), Cardiac Surgery (F.F.T.), and the Pediatric Transplant Center (C.S.D.A., E.D.B., H.J.B., F.F.T., T.P.S.), Children's Hospital Boston; the Department of Pediatrics, Harvard Medical School; and the Department of Biostatistics (K.G.), Harvard School of Public Health; all in Boston, Mass
| | - Gary E Piercey
- Department of Cardiology (C.S.D.A., R.R.T., G.E.P., K.G., E.D.B., H.J.B., T.P.S.), Cardiac Surgery (F.F.T.), and the Pediatric Transplant Center (C.S.D.A., E.D.B., H.J.B., F.F.T., T.P.S.), Children's Hospital Boston; the Department of Pediatrics, Harvard Medical School; and the Department of Biostatistics (K.G.), Harvard School of Public Health; all in Boston, Mass
| | - Kimberlee Gauvreau
- Department of Cardiology (C.S.D.A., R.R.T., G.E.P., K.G., E.D.B., H.J.B., T.P.S.), Cardiac Surgery (F.F.T.), and the Pediatric Transplant Center (C.S.D.A., E.D.B., H.J.B., F.F.T., T.P.S.), Children's Hospital Boston; the Department of Pediatrics, Harvard Medical School; and the Department of Biostatistics (K.G.), Harvard School of Public Health; all in Boston, Mass
| | - Elizabeth D Blume
- Department of Cardiology (C.S.D.A., R.R.T., G.E.P., K.G., E.D.B., H.J.B., T.P.S.), Cardiac Surgery (F.F.T.), and the Pediatric Transplant Center (C.S.D.A., E.D.B., H.J.B., F.F.T., T.P.S.), Children's Hospital Boston; the Department of Pediatrics, Harvard Medical School; and the Department of Biostatistics (K.G.), Harvard School of Public Health; all in Boston, Mass
| | - Heather J Bastardi
- Department of Cardiology (C.S.D.A., R.R.T., G.E.P., K.G., E.D.B., H.J.B., T.P.S.), Cardiac Surgery (F.F.T.), and the Pediatric Transplant Center (C.S.D.A., E.D.B., H.J.B., F.F.T., T.P.S.), Children's Hospital Boston; the Department of Pediatrics, Harvard Medical School; and the Department of Biostatistics (K.G.), Harvard School of Public Health; all in Boston, Mass
| | - Francis Fynn-Thompson
- Department of Cardiology (C.S.D.A., R.R.T., G.E.P., K.G., E.D.B., H.J.B., T.P.S.), Cardiac Surgery (F.F.T.), and the Pediatric Transplant Center (C.S.D.A., E.D.B., H.J.B., F.F.T., T.P.S.), Children's Hospital Boston; the Department of Pediatrics, Harvard Medical School; and the Department of Biostatistics (K.G.), Harvard School of Public Health; all in Boston, Mass
| | - T P Singh
- Department of Cardiology (C.S.D.A., R.R.T., G.E.P., K.G., E.D.B., H.J.B., T.P.S.), Cardiac Surgery (F.F.T.), and the Pediatric Transplant Center (C.S.D.A., E.D.B., H.J.B., F.F.T., T.P.S.), Children's Hospital Boston; the Department of Pediatrics, Harvard Medical School; and the Department of Biostatistics (K.G.), Harvard School of Public Health; all in Boston, Mass
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Abstract
This investigation determined the ages and weights of children that could be supported with 12 and 25 ml Penn State pediatric ventricular assist devices (PVADs) using 6, 8, and 10 mm outlet cannulas and grafts. Future patients will be matched to devices based on cardiac output (CO) and ascending aortic diameter (AA). These were calculated for children 0-10 years with regression formulas given as clinical standards [<5 kg, CO = 0.2171(kg) + 0.0703], [>5 kg, CO = 3.06 (m2) + 0.37], [AA = -0.0427 + 14.54 (m2)1/2]. The 12 ml PVAD will be useful for patients from approximately birth to 3-8 months, weighing 2-7 kg, and having 0.5-1.4 L/min CO; the 25 ml PVAD will be for children 2-6 months to 5-9 years old, weighing 6-23 kg, and having 1.3-3.0 L/min of CO. The 6 mm outlet graft will fit children from 0 to 12 months, weighing 2-8 kg; the 8 mm graft from 0 to 47 months, weighing 4-14 kg; and the 10 mm graft for children 4 months to 8 years, weighing 8-21 kg.
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