Mechanical circulatory support in children: Strategies, challenges and future directions

Abstract

Introduction: The use of mechanical circulatory support (MCS) in the pediatric population has evolved significantly in the past 20 years, but its management still poses several challenges. We aim to describe patient characteristics, outcomes, and morbidity associated with different modalities of MCS, in a tertiary center.

Methods: Retrospective analysis of data from all the children who underwent MCS between 2002 and 2018 at a pediatric cardiology unit.

Results: Between 2002 and 2018, 22 devices were implanted in 20 patients. Patients were divided into three groups: Group A (n=11) extracorporeal membrane oxygenator (ECMO); Group B (n=8) pulsatile paracorporeal ventricular assist device (VAD) and group C (n=3) paracorporeal continuous flow VAD. The median age was similar in groups A and B (18 and 23 months, respectively), and higher in group C (13 years). ECMO patients were cannulated mainly as a bridge to recovery (post cardiotomy- 8) while group B and C patients were bridged to transplantation. The most frequent complications were bleeding (group A - 36%, group C - 66.6%) and thromboembolic events (group B - 50%, group C - 33.3%). As for outcomes, in group A the majority of patients (54.5%) were weaned and 27.3% died. Half of group B and all of group C patients underwent transplantation.

Conclusion: Bleeding and thromboembolic events were the main complications observed. Group B showed the highest mortality, probably related to the low weight of the patients. Overall, outcomes and complications are related to the type of device and patient status and characteristics.

Keywords: Assistência mecânica circulatória; Assistência ventriculares de curta duração; Assistência ventriculares paracorporais pulsáteis; Bridge to transplant; Bridge-to-bridge; ECMO; Heart transplant; Mechanical circulatory support; Paracorporeal pulsatile ventricular assist devices; Pediatric; Pediátrico; Ponte para ponte; Ponte para transplante; Short term ventricular assist devices; Transplante cardíaco.