Comparison of paracorporeal and continuous flow ventricular assist devices in children: preliminary results†
- 16 February 2017
- journal article
- research article
- Published by Oxford University Press (OUP) in European Journal of Cardio-Thoracic Surgery
- Vol. 51 (4), 709-714
- https://doi.org/10.1093/ejcts/ezx006
Abstract
OBJECTIVES: With the scarcity of organs, a durable, reliable ventricular assist device (VAD) is required. The Berlin Heart EXCOR® (BH) remains the most established VAD in the paediatric population. Implantable continuous flow (CF) VADs have been introduced to the paediatric field with encouraging early results. In this study, we compared the results of a newly introduced CF VAD (HeartWare VAD [HVAD]®) to results in a matched group of BH recipients. METHODS: The study included patients aged <16 years who received mechanical left VAD (LVAD) support between December 2005 and January 2016. The preimplant characteristics and postimplant outcomes of patients who received the HVAD were compared with those of a matched group who received the BH. Patients with congenital heart disease were excluded. RESULTS: Thirty patients were included in the study: 13 had received the HVAD and were matched with 17 patients who had received the BH LVAD. The only difference in preimplant characteristics was the need for higher inotropic support in the BH group. There was no difference in the need for right ventricular (RV) support (58.8% for BH vs 53.8% for HVAD, P = 1.00) or in the incidence of cerebrovascular accidents (12.5% vs 7.7%, respectively, P = 1.00), though the BH group showed prolonged mechanical ventilation (31.3% vs 0%, P = 0.047). There were no deaths while on VAD support in either group. Patients with the HVAD showed a bimodal distribution for the primary end point (transplant/explant): All HVAD recipients who also required early RV support reached this end point within 30 days of receiving the implant. CONCLUSIONS: Our early experience with the CF intracorporeal LVAD system (HVAD) indicates outcomes comparable to those with the well-established pulsatile flow paracorporeal LVAD (BH). The theoretical durability of the CF device, which might also allow for the possibility of hospital discharge and better quality of life, is yet to be proven.Keywords
This publication has 25 references indexed in Scilit:
- An Extended Role of Continuous Flow Device in Pediatric Mechanical Circulatory SupportThe Annals of Thoracic Surgery, 2016
- A multicenter study of the HeartWare ventricular assist device in small childrenThe Journal of Heart and Lung Transplantation, 2016
- Early Outcomes With HeartWare HVAD as Bridge to Transplant in Children: A Single Institution ExperienceArtificial Organs, 2015
- Mechanical cardiac support in children with congenital heart disease with intention to bridge to heart transplantationEuropean Journal of Cardio-Thoracic Surgery, 2014
- HeartWare Ventricular Assist Device as Bridge to Transplant in Children and AdolescentsArtificial Organs, 2013
- Prospective Trial of a Pediatric Ventricular Assist DeviceThe New England Journal of Medicine, 2012
- Outcomes With Ventricular Assist Device Versus Extracorporeal Membrane Oxygenation as a Bridge to Pediatric Heart TransplantationArtificial Organs, 2010
- Vasoactive–inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass*Pediatric Critical Care Medicine, 2010
- INTERMACS Profiles of Advanced Heart Failure: The Current PictureThe Journal of Heart and Lung Transplantation, 2009
- Incidence, Causes, and Outcomes of Dilated Cardiomyopathy in ChildrenJama-Journal Of The American Medical Association, 2006