Ventricular assist devices act as a bridge to transplant

Smaller Berlin Heart EXCOR ® VAD now FDA-approved in children

Despite many improvements in the treatment of children with heart disease, heart failure that resists medical therapy remains a problem in the pediatric population. For the most severe forms of heart failure, heart transplantation has emerged as an effective therapy, affording longevity and a higher quality of life.

To keep children alive until a suitable donor organ becomes available, mechanical circulatory support is often needed. Historically, nonpulsatile devices such as extracorporeal membrane oxygenation (ECMO) and centrifugal pumps have been used. ECMO has the advantage of providing immediate cardiopulmonary support. However, with the shortage of donor hearts and the resulting waiting times, the use of these devices may be hazardous. Support with ECMO and centrifugal assist devices for prolonged periods of time is associated with significant risks, including bleeding, sepsis and neurologic complications. Also, the intricate circuits require the patient to be immobile, which has a negative impact on rehabilitation.

Similarly, if a child is treated with medicine alone before transplant, the results can be just as poor. If the child is too weak to eat well and does not have the energy to walk and move around, he or she cannot rehabilitate before transplant.

More appropriate circulatory support can be provided by a mechanical ventricular assist device (VAD), which acts as a bridge to heart transplantation, allowing for long-term support. These improve patients’ circulation and reverse end-organ dysfunction while permitting physical rehabilitation to improve the patient’s overall condition and likelihood for successful transplantation.

Some intermediate-sized children and adolescents may be candidates for VADs used in adults. In the United States, the FDA also recently approved the Berlin Heart EXCOR ® VAD as a bridge to transplant in children who are too young to be candidates for VADs used in adults.

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