Implantation of HeartWare Left Ventricular Assist Device in Pediatric Population

摘要

The new-generation continuous-flow left ventricular assist devices (VAD) have dramatically improved clinical outcomes of adult patients with end-stage heart failure in the current era.1 In the adult population, multiple devices are available as a long-term bridge to transplantation2 and as destination therapy1 with low device-related morbidity and mortality. On the contrary, long-term mechanical circulatory support options in the pediatric population have been extremely limited. Pediatric patients with end-stage heart failure have traditionally been supported with extracorporeal membrane oxygenation with dismal success rate for bridge to transplantation owing to extracorporeal membrane oxygen-ation-related complications.3 Recent clinical application of the EXCOR pediatric assist device (Berlin Heart), a paracorporeal pulsatile-flow VAD, has substantially improved the survival of the patients who were bridged to transplantation with VAD.4 Nonetheless, approximately one-third of the patients who are supported with the Berlin Heart have embolic stroke and other major complications.4 Adult-sized VADs have been used in adolescents and some selected patients with a high rate of bridge to transplantation5; however, the mismatch between device and body sizes precludes routine use of adult-sized VADs in the pediatric population.