Ventricular assist device application as a bridge to pediatric heart transplantation: A single center's experience
Journal
Transplantation Proceedings
Journal Volume
44
Journal Issue
4
Pages
883
Date Issued
2012-05
Author(s)
Hsu K.H.
Tsao C.I.
Ko W.J.
Abstract
Objectives: There are limited options for mechanical circulatory support to treat end-stage heart failure in pediatric patients. Although extracorporeal membrane oxygenation is commonly used in infants and children, ventricular assist devices (VAD) provide a longer duration of support with fewer complications before recovery or as a bridge to heart transplantation (HTx), as described herein. Methods: This retrospective chart review of eight patients transplanted from April 2008 to December 2011, after left ventricular assist device (LVAD) implantation due to end-stage heart failure. Their mean age was 12 years (9-15 y) and mean body weight, 48 kg (20-78). All were New York Heart Association functional class IV with mean left ventricular ejection fractions less than 15%. Results: The six patients (75%) received HTx after a mean LVAD support duration of 43.2 days; 2 (25%) died before a suitable heart became available. Their mean duration of LVAD support was 30 days. There were 4 (50%) who experienced clinically evident thromboembolic events: 3 (37.5%) cerebrovascular with 1 mortality and 1 (12.5%) as acute limb ischemia. Transient hemodialysis was performed in 4 (50%). Bloodstream infection identified in 6 (75%) was controlled with intravenous antibiotics. Driveline infection identified in 4 (50%) was treated successfully with local wound dressing changes and intravenous antibiotics. One 9-year-old boy died of rejection at 16 months after transplantation. Conclusions: Because of the organ shortage, pediatric patients have a low chance to undergo HTx. VAD provides long-term support for children with end-stage heart failure before a suitable heart becomes available. A thromboembolic event remains a major complication influencing their survival. ? 2012 Elsevier Inc.
SDGs
Other Subjects
antibiotic agent; ceftazidime; vancomycin; artery disease; bloodstream infection; body weight; brain disease; brain hemorrhage; cardiac graft rejection; cerebral artery disease; cerebrovascular accident; conference paper; heart failure; heart left ventricle ejection fraction; heart transplantation; hemodialysis; human; left ventricular assist device; leg ischemia; medical record review; medical society; mortality; pediatric surgery; postoperative complication; priority journal; resuscitation; surgical mortality; thrombectomy; thromboembolism; wound dressing; Adolescent; Child; Female; Graft Rejection; Heart Failure; Heart Transplantation; Heart-Assist Devices; Humans; Male; Prosthesis Design; Retrospective Studies; Taiwan; Thromboembolism; Time Factors; Tissue Donors; Treatment Outcome; Ventricular Function, Left; Waiting Lists
Type
conference paper