Oral Session 3
Mechanical circulatory support

[ISPHLT-OS3-3] Long-term ventricular assist device support in children

^○Motoki Komori¹, Takaya Hoashi¹, Kenta Imai¹, Naoki Okuda¹, Heima Sakaguhi², Kenichi Kurosaki², Norihide Fukushima³, Hajime Ichikawa¹ (1.Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Japan, 2.Pediatric Cardiology, 3.Transplant Medicine)

[Background] The shortage of donor organs in Japan is severe especially in children with end-stage heart failure awaiting heart transplantation (HT). Then, long-term ventricular assist device (VAD) support increases the risk of several complications. [Patients] 20 patients under 15 years old underwent mechanical circulatory support with EXCOR pediatric between 2015 and 2020 (18 LVAD, 2 BiVAD). Over all outcomes were evaluated. [Results] The median age, body surface area at VAD implantation, and VAD support periods were 64.5 months of age (range: 1.8-144.0), 0.66 m2 (0.19-1.18), and 13.3 months (2.0-30.1). The main diagnoses were dilated cardiomyopathy (DCM) for 17 patients and myocarditis for 3 patients. 7 patients (3 domestic and 4 abroad) underwent HT with the average support periods of 10 months. Morbidity was observed in 1 patient due to sepsis. Currently, 7 patients are on EXCOR support. 11 patients were on over 12 months support. (Recovery) Weaning from EXCOR was achieved in 5 patients with the average support periods of 9.1 months. One of them weaned from LVAD after 24 months support for DCM. Her histological findings showed the improvement of myocardial fibrosis in Masson's trichrome staining at mid-mural layer. (Long-term VAD-related complications) Infection free survival rates at 12 months and 24 months were 53 % and 18 %, respectively. Complications free survival rates at 12 months and 24 months were 55 % and 28 %, respectively. Complications include membrane fracture in 2 pumps, thrombus formation which necessitate pump exchange in 6 pumps, and cannula dislocation in 1 patient. (Cannula dislocation case) 18-month-old girl underwent LVAD implantation for DCM. Her height increased by 12 cm within 12 months. The inflow cannula was unexpectedly detached from apex and a pseudoaneurysm was formed around apex after 12 months support, then, emergent removal of the pseudoaneurysm and re-implantation of the inflow cannula were performed. [Conclusion] Complications of long-term VAD support, including incidence of cannula exit site infections and pump related adverse events increased by time. Recovery of left ventricular function was frequently seen, even long after VAD implantation.