Mechanical Circulatory Support Devices in Pediatric Patients
Acute heart failure can occur in children as a result of hemodynamic insults imposed on the heart by structural congenital defects or in anatomically normal hearts in which the myocardium is damaged by an inflammatory or infectious process (myocarditis, m
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Mark D. Plunkett and James D. St. Louis
Abstract
Acute heart failure can occur in children as a result of hemodynamic insults imposed on the heart by structural congenital defects or in anatomically normal hearts in which the myocardium is damaged by an inflammatory or infectious process (myocarditis, metabolic diseases leading to cardiomyopathy). Postcardiotomy heart failure following surgical repair of congenital heart defects can also lead to the need for postoperative support. Mechanical circulatory support devices have been used successfully as a bridge to recovery in children, especially in the management of acute myocarditis or postcardiotomy heart failure. The use of these devices as a bridge to transplantation has also been shown to decrease waiting list mortalities and improve the efficiency of donor organ utilizations in children. However, currently available mechanical circulatory support options for infants and children are still quite limited, especially with regard to size options for smaller patients and the long-term duration of support often required. Future devices are currently in development for clinical use on a broad scale and will greatly facilitate the successful support of children with heart failure as a bridge to myocardial recovery or heart transplantation. Keywords
Pediatric ventricular assist device • Pediatric heart transplant • Cardiomyopathy • Myocarditis • Heart failure in children
11.1
Introduction
The development of devices designed for pediatric circulatory support has origins in the history of cardiopulmonary bypass (CPB) and the advent and development of adult ventricular assist devices (VADs). For many years, extracorporeal membrane oxygenation (ECMO) was the only reliable option for pediatric patients with heart failure, but this was M.D. Plunkett, MD (*) University of Illinois College of Medicine, Children's Hospital of Illinois, 420 N.E. Glen Oak Avenue, Peoria, IL 61603, USA e-mail: [email protected]; [email protected] J.D. St. Louis, MD University of Missouri-Kansas City, School of Medicine, Children’s Mercy Hospital and Clinics, Kansas City, MO, USA
only effective for short-term use. The recent miniaturization of existing technologies and the introduction of new technologies have produced potential new options and have advanced the field of pediatric mechanical circulatory support to the forefront of pediatric heart surgery. These recent advances are leading to a new and exciting world of future options for children with heart failure secondary to congenital or acquired heart disease.
11.2
Historical Notes
The history of pediatric mechanical support has its roots in the development of CPB and open-heart surgery and runs in parallel to the development of adult mechanical cardiac support. In May 1951, Dr. Gibbon used the Gibbon-IBM heart-lung
© Springer International Publishing Switzerland 2015 P.A. Iaizzo (ed.), Handbook of Cardiac Anatomy, Physiology, and Devices, DOI 10.1007/978-3-319-19464-6_11
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M.D. Plunkett and J.D. St. Louis
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