Supporting pediatric patients with short-term continuous-flow devices

https://doi.org/10.1016/j.healun.2016.01.1224Get rights and content

Background

Short-term continuous-flow ventricular assist devices (STCF-VADs) are increasingly being used in the pediatric population. However, little is known about the outcomes in patients supported with these devices.

Methods

All pediatric patients supported with a STCF-VAD, including the Thoratec PediMag or CentriMag, or the Maquet RotaFlow, between January 2005 and May 2014, were included in this retrospective single-center study.

Results

Twenty-seven patients (15 girls [56%]) underwent 33 STCF-VAD runs in 28 separate hospital admissions. The STCF-VAD was implanted 1 time in 23 patients (85%), 2 times in 2 patients (7%), and 3 times in 2 patients (7%). Implantation occurred most commonly in the context of congenital heart disease in 14 runs (42.2%), cardiomyopathy in 11 (33%), and after transplant in 6 (18%). The median age at implantation was 1.7 (interquartile range [IQR] 0.1, 4.1) years, and median weight was 8.9 kg (IQR 3.7, 18 kg). Patients were supported for a median duration of 12 days (IQR 6, 23 days) per run; the longest duration was 75 days. Before implantation, 15 runs (45%) were supported by extracorporeal membrane oxygenation (ECMO). After implantation, an oxygenator was required in 20 runs (61%) and continuous renal replacement therapy in 21 (64%). Overall, 7 runs (21%) resulted in weaning for recovery, 14 (42%) converted to a long-term VAD, 4 (12%) resulted in direct transplantation, 3 (9%) were converted to ECMO, and 5 (15%) runs resulted in death on the device or within 1 month after decannulation. The most common complication was bleeding requiring reoperation in 24% of runs. In addition, 18% of runs were associated with neurologic events and 15% with a culture-positive infection. Hospital discharge occurred in 19 of 28 STCF-VAD admissions (67%). In follow-up, with a median duration of 9.2 months (IQR 2.3, 38.3 months), 17 patients (63%) survived.

Conclusions

STCF-VADs can successfully bridge most pediatric patients to recovery, long-term device, or transplant, with an acceptable complication profile. Although these devices are designed for short-term support, longer support is possible and may serve as an alternative approach to patients not suitable for the current long-term devices.

Section snippets

Methods

The local Research Ethics Board approved the study protocol, and the requirement for individual patient consent was waived.

Demographics and clinical outcomes

From 2005 to 2014, 27 children (15 girls [56%]) were supported with a STCF-VAD with a total of 33 runs in 28 separate hospital admissions (Table 1), comprising 85% (n = 23) with 1 run, 7% (n = 2) experienced 2, and an additional 7% (n = 2) were supported on three occasions. At the time of implant, the patients were a median age of 1.7 years (IQR 0.1, 4.1 years) with a median weight of 8.9 kg (IQR 3.7, 18 kg). The most common reason for implantation during the 33 runs was congenital heart

Discussion

Acute heart failure occurs in a number of different settings in pediatrics. STCF-VAD support permits time for decisions to be made about the potential for myocardial recovery and allows for a detailed assessment of end-organ function. ECMO is another option for short-term support for acute cardiopulmonary failure, but survival to hospital discharge remains a challenge, with reports of 32% to 73% in single centers studies8, 9, 10, 11, 12, 13 and 40% to 50% for pediatric cardiac ECMO from the

Conclusions

STCF-VADs can successfully bridge pediatric patients to recovery, a long-term device, or transplant in most cases, with an acceptable complication rate. Although these devices are designed for short-term support, longer support is possible and may be an alternative support strategy for patients who are not suitable for the current long-term devices. Further studies are required to better understand the complication profile and the ideal management strategy, including anti-coagulation, for

Disclosure statement

None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

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