Experience with Temporary Centrifugal Pump Bi-ventricular Assist Device for Pediatric Acute Heart Failure: Comparison wi
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ORIGINAL ARTICLE
Experience with Temporary Centrifugal Pump Bi‑ventricular Assist Device for Pediatric Acute Heart Failure: Comparison with ECMO Jae Hong Lim1 · Jae Gun Kwak2 · Jooncheol Min2 · Hye Won Kwon3 · Mi Kyung Song3 · Gi Beom Kim3 · Eun Jung Bae3 · Woong‑Han Kim2 · Jeong Ryul Lee2 Received: 2 December 2019 / Accepted: 8 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Though ventricular assist devices (VADs) are an important treatment option for acute heart failure, an extracorporeal membrane oxygenator (ECMO) is usually used in pediatric patients for several reasons. However, a temporary centrifugal pump-based Bi-VAD might have clinical advantages versus ECMO or implantable VADs. From January 2000 to July 2018, we retrospectively reviewed 36 pediatric patients who required mechanical circulatory support (MCS) for acute heart failure. Cases with postoperative MCS were excluded. Since 2016, we have tried to immediately add a right VAD rather than ECMO, when the patients begin to present features of right heart failure after left VAD support started in cases that the patients’ respiratory function did not require an oxygenator. Original diagnoses included dilated cardiomyopathy (n = 18), myocarditis (n = 11), and others (n = 7). Eleven patients were supported by Bi-VAD, and 25 patients were supported by ECMO; of these. Four patients were successfully weaned from VAD, and 10 patients were weaned from ECMO. Eleven patients underwent heart transplantation. Overall, we have 15 (41.7%) early mortalities. There were no significant differences in early mortality, morbidity, and weaning rate between the Bi-VAD group and the ECMO group. During the support, patients with Bi-VADs significantly required fewer platelets and showed less hemolysis than ECMO patients. Patients with myocarditis were successfully weaned from Bi-VAD support and bridged to transplantation thereafter. A temporary centrifugal pump-based Bi-VAD was clinically comparable to ECMO for pediatric patients with acceptable pulmonary function. Keywords Pediatric · Heart failure · Ventricular assist device
Introduction
This topic was presented in poster session in 55th “The Society of Thoracic Surgeons” annual meeting in San Diego, CA, January 27, 2019–January 29, 2019. * Jae Gun Kwak [email protected] 1
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeong‑Gi, Republic of Korea
2
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
3
Department of Pediatrics, Seoul National University Children’s Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
Mechanical circulatory support (MCS) has become an important treatment option for patients with acute decompensated heart failure that is refractory to other medical therapies [1]. Many studies reported various results of MCS including extracorporeal membrane oxy
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