Symposium 5
Pediatric mechanical circulatory support in children and patients with congenital heart disease

[ISPHLT-SY5-1] Evolving strategies in mechanical circulatory support in children with congenital heart disease: SickKids experience

^○Osami Honjo^{1,2,3,4,5,6,7,8} (1.Department of Cardiovascular Surgery, The Hospital for Sick Children, Canada, 2.Watson Family Chair, Cardiovascular Sciences, The Hospital for Sick Children, 3.Associate Professor, Department of Surgery, University of Toronto, 4.Senior Associate Scientist,)

Incremental improvement of management for infants and children who are supported by ventricular assist device (VAD) resulted in high rate of bridge to transplantation among those patients with less morbidities. Recent practice changes, introduction of direct thrombin inhibitor bivalriudin and the use of continuous flow VAD such as HeartWare and Heartmate III, further improved the clinical outcomes. Nonetheless the patients with congenital heart disease (CHD) carries much higher risk of morbidities and mortality during VAD support compared to non-CHD population and therefore histologically had much lower rate of successful bridge to transplantation. Patients with CHD and ventricular dysfunction who require VAD support has multiple challenges, such as history of previous sternotomy, various ventricular morphology and location, different physiologic and palliative status, and potential end organ dysfunction. Herein the current clinical practice, device selection, and special considerations of VAD for patients with CHD are discussed. In addition, technical challenges in some unique anatomic subgroups, such as corrected transposition of the great arteries and single ventricle physiology are discussed.