Pediatric ventricular assist devices: current challenges and future prospects
Open Access
- 1 May 2017
- journal article
- review article
- Published by Taylor & Francis in Vascular Health and Risk Management
- Vol. ume 13, 177-185
- https://doi.org/10.2147/vhrm.s82379
Abstract
Pediatric ventricular assist devices: current challenges and future prospects Sarah Burki,1,2 Iki Adachi1,2 1Division of Congenital Heart Surgery, Texas Children’s Hospital, 2Department of Surgery and Pediatrics, Baylor College of Medicine, Houston, TX, USA The field of mechanical circulatory support has made great strides in the preceding 2 decades. Although pediatric mechanical circulatory support has lagged behind that of adults, the gap between them is expected to close soon. The only device currently approved by the US Food and Drug Administration for use in children is the Berlin Heart EXCOR ventricular assist device (VAD). The prospective Berlin Heart Investigational Device Exemption Trial demonstrated good outcomes, such as bridge to transplantation or recovery, in ~90% of children supported with this device. However, a high incidence of hemorrhagic and thrombotic complications was also noted. As a result, pediatric centers have just started implanting adult intracorporeal continuous-flow devices in children. This paradigm shift has opened a new era in pediatric mechanical circulatory support. Whereas children on VAD were previously managed exclusively in hospital, therapeutic options such as outpatient management and even destination therapy have been becoming a reality. With continued miniaturization and technological refinements, devices currently in development will broaden the range of options available to children. The HeartMate 3 and HeartWare MVAD are two such compact VADs, which are anticipated to have great potential for pediatric use. Additionally, a pediatric-specific continuous-flow VAD, the newly redesigned Jarvik Infant 2015, is currently undergoing preclinical testing and is expected to undergo a randomized clinical trial in the near future. This review aims to discuss the challenges posed by the use of intracorporeal adult continuous-flow devices in children, as well as to provide our perspective on the future prospects of the field of pediatric VADs. Keywords: children, mechanical circulatory support, MCS, single ventricle, SV, chronic graft dysfunction, anticoagulation, miniaturizationKeywords
This publication has 45 references indexed in Scilit:
- A multicenter study of the HeartWare ventricular assist device in small childrenThe Journal of Heart and Lung Transplantation, 2016
- Pulmonary Artery Band Reduces Left Atrial Pressure in Dilated CardiomyopathyThe Annals of Thoracic Surgery, 2015
- Antithrombotic therapy for ventricular assist devices in children: do we really know what to do?Journal of Thrombosis and Haemostasis, 2015
- Mechanical Circulatory Support in Univentricular Hearts: Current ManagementSeminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual, 2015
- A modified implantation technique of the HeartWare ventricular assist device for pediatric patientsThe Journal of Heart and Lung Transplantation, 2015
- Outcomes of pediatric patients supported by the HeartMate II left ventricular assist device in the United StatesThe Journal of Heart and Lung Transplantation, 2013
- Berlin Heart EXCOR Pediatric Ventricular Assist Device for Bridge to Heart Transplantation in US ChildrenCirculation, 2013
- Fifth INTERMACS annual report: Risk factor analysis from more than 6,000 mechanical circulatory support patientsThe Journal of Heart and Lung Transplantation, 2013
- Prevalence, Morbidity, and Mortality of Heart Failure–Related Hospitalizations in Children in the United States: A Population-Based StudyJournal of Cardiac Failure, 2012
- First Experiences With the HeartWare Ventricular Assist System in ChildrenThe Annals of Thoracic Surgery, 2011