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Technology Insight: use of ventricular assist devices in children

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 377–386 (2006)Cite this article

Abstract

Mechanical circulatory support systems for the treatment of end-stage heart failure are now available for a wide variety of clinical situations and support times. Extracorporeal membrane oxygenation and centrifugal pump circuits have been most widely used in children, particularly in small infants. These systems are preferred for support after cardiac operations and for use in patients who have concomitant respiratory failure, but are suitable for short-term application only and intensive care is obligatory. True ventricular assist devices (VADs) qualify for long-term application and allow patients full mobilization. These features are important in patients awaiting heart transplantation as well as in those with myocarditis and cardiomyopathy, who might achieve complete cardiac recovery. Pneumatic pulsatile VADs have been available in pediatric sizes since 1992. At our institution, VAD use lasting from several days to 14 months in 70 infants and children with myocarditis and cardiomyopathy has led to a notable rise in survival in the past 5 years. We have been able to discharge 78% of the infants under 1 year old. In this review we present current VAD experience in children in the light of improvements in decision making, device technology, implantation techniques, and in coagulation monitoring and anticoagulation.

Key Points

  • In life-threatening heart failure, treatment with ventricular assist devices is gaining an increasingly important role, even in small infants and children

  • For postoperative, short-term support or for combined heart and lung failure extracorporeal membrane oxygenation is the most widespread device

  • In cases of cardiomyopathy or myocarditis or if long-term bridging to recovery or transplantation is expected for other reasons, use of pneumatic pulsatile devices is the strategy of choice

  • Pulsatile ventricular assist devices provide additional time to restore organ function; extubation, mobilization and enteral nutrition are mostly successful and, if no spontaneous improvement occurs, the chances for transplantation have been increased

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Figure 1: Adult (left) and pediatric (right) Berlin Heart Excor® (Berlin Heart AG, Berlin, Germany) ventricular assist devices.
Figure 2: Different types and sizes of ventricular assist device cannulae.
Figure 3: Standard configuration of Berlin Heart Excor® (Berlin Heart AG, Berlin, Germany) biventricular support.
Figure 4: A Berlin Heart Excor® (Berlin Heart AG, Berlin, Germany) left ventricular assist device with 10 ml stroke volume, implanted in a 5-month-old infant.

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Acknowledgements

We thank Ms A Gale, medical editor, for editorial assistance. Significant contributions to the surgery and intensive care of the children at the Deutsches Herzzentrum Berlin have been made by Y Weng, M Huebler, V Alexi-Meshkishvili, E Henning, F Kaufmann, W Böttcher, M Redlin and F Berger. Written consent for publication of the photograph in Figure 4 was obtained from the patient's parents.

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Authors and Affiliations

  1. Chairman of the Deutsches Herzzentrum Berlin and a professor of surgery in the Department of Thoracic and Cardiovascular Surgery,

    Roland Hetzer & Brigitte Stiller

  2. pediatrician in the Department of Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany

    Roland Hetzer & Brigitte Stiller

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  1. Roland Hetzer
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  2. Brigitte Stiller
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Correspondence to Roland Hetzer.

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Competing interests

Roland Hetzer and Brigitte Stiller act as consultants to Berlin Heart AG, Berlin, Germany.

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Hetzer, R., Stiller, B. Technology Insight: use of ventricular assist devices in children. Nat Rev Cardiol 3, 377–386 (2006). https://doi.org/10.1038/ncpcardio0575

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