Current Challenges and Strategies of Ventricular Assist Device Support in Infants and Small Children
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Cardiology/CT Surgery (K Gist, Section Editor)
Current Challenges and Strategies of Ventricular Assist Device Support in Infants and Small Children Michelle S. Ploutz, MD1,* Angela Lorts, MD2 David M. Peng, MD3 Address *,1 Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, 81 N. Mario Capecchi Dr., Salt Lake City, UT, 84113, USA Email: [email protected] 2 Department of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA 3 Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Cardiology/CT Surgery Keywords Pediatric ventricular assist device I Mechanical circulatory support I Pediatric heart failure I Berlin EXCOR I Bivalirudin
Abstract Purpose of Review Ventricular assist devices (VADs) have become a mainstay of advanced heart failure therapy in pediatrics, with outcomes in adolescents that parallel the excellent outcomes in adults. Unfortunately, outcomes for younger children and infants remain suboptimal. This review discusses the patient and device specifics that contribute to this discrepant outcome, highlight current treatment strategies, and suggest areas for future improvement. Recent Findings The field of pediatric mechanical circulatory support (MCS) continues to be driven by advancements in patient selection, timing of VAD implantation, and patient management strategies particularly with regard to anticoagulation. The use of direct thrombin inhibitors, such as bivalirudin, and weight-based antiplatelet therapy has shown promise in reducing the incidence of bleeding and stroke. While the number of devices remains limited, providers continue to leverage current technology and novel cannulation strategies to support smaller and more complex patients. Summary Despite the challenges of supporting infants and small children, it remains a hopeful time for the field of pediatric MCS. While individual centers may only care for small number of VAD patients, the ACTION learning network has
Cardiology/CT Surgery (K Gist, Section Editor) sparked collaboration across the field broadly with rapid dissemination of best practices to all centers. This collaboration has led to many advances and holds promise for driving future advancements.
Introduction The population of children with end-stage heart failure has steadily increased over the past decade. This dramatic growth has been driven by improved education and advanced imaging techniques for the recognition of myocardial disease in children. In addition, advances in surgical palliation of congenital heart disease (CHD) have improved survival, but at the cost of increased heart failure morbidity later in life. Unfortunately, the number of heart transplants has remained fairly constant since the early 2000s, averaging around 500 transplants annually [1]. With these shifts in supply and demand, mechanical circulatory support (MCS) offers a means for patient stabiliz
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