[AJS-01] The Management of Severe Heart Failure: Elective Implantation of Ventricular Assist Device versus Medical Management?
The field of pediatric heart failure has come a long way and it is now a burgeoning field. The impetus to its growth has to do with the strength of scientific and clinical evidence coming out of the adult heart failure literature; the strong interest among multiple cardiovascular subspecialties in pediatrics, from surgery to critical care to cardiology; the growing number of children with ventricular dysfunction from palliated congenital heart disease as well as cardiomyopathies; and the advent of improved and smaller durable ventricular assist devices. With these changes also come more questions on how best to apply various therapies to patients with severe heart failure. Specifically, for those who are hemodynamically stable on inotrope(s) while either listed for transplant, or not listed because they may recover over time (myocarditis) or are not candidates for transplant (destination therapy), is it better to go with ventricular assist device or medical therapy alone? Through the exercise of reviewing data available for ventricular assist device and for chronic and acute medical management in children as well as adults, it is hoped that we can come to a better understanding, if not what to do, with this clinical dilemma.