Pediatric Ventricular Assist Device

Abstract

There have been great advances in ventricular assist device (VAD) treatment for pediatric patients with advanced heart failure. VAD support provides more time for the patient in the heart transplant waiting list. Augmented cardiac output improves heart failure symptoms, end-organ function, and general condition, and consequently provides beneficial effects on post-transplant outcomes. Miniaturized continuous flow devices are more widely adopted for pediatric patient with promising results. For infants and small children, still paracorporeal pulsatile device is the only option for long-term support. Younger age, congenital heart disease, biventricular support, patient's status and end-organ dysfunction at the time of implantation are risks for poor outcomes. Patient selection, timing of implantation, and selection of device for each patient are critical for optimal clinical outcomes.

Keywords: Cardiac transplantation; Extracorporeal membranous oxygenation; Heart failure; Pediatric; Ventricular assist device.

Figure 1. Chest X-ray (A-C) and echocardiogrphic finding (D-F) before and after LVAD support. (A, D) pre-LVAD support, (B, E) post-LVAD support 2 weeks, (C, F) post-implantation 5 months. Serial chest-ray demonstrates the progressive decreased heart size and pulmonary congestion. On pre-LVAD support echocardiography, left ventricle was dilated and interventricular septum was deviated to the right. After LVAD support, left ventricle is unloaded and interventricular septum is in neutral position.

LVAD = left ventricular assist device.