8:40 AM - 10:10 AM
[I-S01-01] The Current Status of Ventricular Assist Devices in Children
Though the treatment of children with acquired and congenital heart disease has advanced significantly in recent years, a subset of patients will experience refractory myocardial failure. In an effort to keep the patient alive until a suitable donor organ becomes available for transplantation or until sufficient myocardial recovery occurs, mechanical circulatory support may be necessary. Options for mechanical support in children include miniaturized intraaortic balloon pumps, extracorporeal membrane oxygenation (ECMO), centrifugal pumps, and, more recently, long-term pulsatile and axial flow ventricular assist devices (VADs). There has been much recent interest in the application of VADs in children with end-stage heart failure. The increasing success of the Berlin Heart ventricular assist device in Europe has spawned much increased use of this device in North America over the past decade. Ventricular assist devices have potential advantages over ECMO as a mechanical bridge. They provide better tissue perfusion and specifically provide better recruitment of the microcirculation of the brain, lungs, and kidneys during extracorporeal circulation. In addition to improving the patient's hemodynamic status and reversing end-organ dysfunction, VADs can be partially or fully implanted and allow for physical rehabilitation to improve the patient's overall condition and likelihood for successful transplantation. Active research is now ongoing to further develop and refine pediatric pumps. This presentation reviews preoperative, intraoperative, and postoperative considerations, with respect to the pediatric population undergoing insertion of a ventricular assist device.