Advertisement

Pediatric Ventricular Assist Device (VAD) as Successful Bridge to Heart Transplantation

  • Guilherme Henrique Ribeiro de CarvalhoEmail author
  • Vanessa Lopes Vieira
  • Leandro Pedro Goloni Bertollo
  • Fabio Biscegli Jatene
  • Luiz Fernando Caneo
Chapter

Abstract

Introduction. Mechanical circulatory support (MCS) devices are a consolidate option for patients who are on the list for a transplant or dramatically unstable and an important tool for children who underwent cardiogenic shock, especially in the context of scarcity of donors and in which there has been an important increase in hospitalizations for pediatric heart failure. Case report. We present the case of a 1-year-old male infant presenting flu symptoms when he was 30 days old and with an evolving low cardiac output and cardiorespiratory arrest. He needed increased doses of vasoactive drugs and was diagnosed in our service with dilated cardiomyopathy, important left ventricular dysfunction of unknown etiology, left ventricular ejection fraction of 24%, mild right ventricular dysfunction, and septic/cardiogenic shock, and was listed for heart transplantation. A few days later, he had an important worsening of the hemodynamic parameters and was referred to our pediatric cardiovascular surgery team. He was evaluated for surgery, and ECMO was indicated as an emergency procedure. Eight days after, since he presented important pulmonary improvement, VAD implant was indicated as a bridge to transplantation; the infant then underwent a new surgery for implantation of a 10 mL left ventricular assistance device (Berlin Heart EXCOR®). Since he became hemodynamically stable, was extubated, and both his hepatic and kidney functions were normal, he was listed for transplantation again. After a good evaluation in the 11 months that followed, he finally underwent cardiac transplantation and is currently stable. Conclusion. MCS is an important alternative as a bridge to heart transplantation with a big potential to change the survival rates after the surgical procedure. The challenges for its pediatric use remain a relevant issue, mainly to developing countries such as Brazil, where the investment in education is the key to achieve similar results as the centers of excellence abroad.

Bibliography

  1. 1.
    Kantor PF, Lougheed J, Dancea A, McGillion M, Barbosa N, Chan C, et al. Presentation, diagnosis, and medical management of heart failure in children: Canadian Cardiovascular Society guidelines. Can J Cardiol. 2013;29(12):1535–52.CrossRefGoogle Scholar
  2. 2.
    Nandi D, Rossano JW. Epidemiology and cost of heart failure in children. Cardiol Young. 2015;25(8):1460–8.CrossRefGoogle Scholar
  3. 3.
    Canter CE, Shaddy RE, Bernstein D, Hsu DT, Chrisant MR, Kirklin JK, et al. Indications for heart transplantation in pediatric heart disease: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young; the Councils on Clinical Cardiology, Cardiovascular Nursing, and Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;115(5):658–76.CrossRefGoogle Scholar
  4. 4.
    Caneo LF, Miana LA, Tanamati C, Penha JG, Shimoda MS, Azeka E. Use of short-term circulatory support as a bridge in pediatric heart transplantation. Arq Bras Cardiol [online]. 2015;104(1 [cited 2016-09-26]):78–84.Google Scholar
  5. 5.
    Caneo LF, Jatene MB. Pediatric mechanical circulatory support systems in Latin America. Artif Organs. 2016;40(10):925–8.CrossRefGoogle Scholar
  6. 6.
    Almond CS, Singh TP, Gauvreau K, Piercey GE, Fynn-Thompson F, Rycus PT, Bartlett RH, Thiagarajan RR. Extracorporeal membrane oxygenation for bridge to heart transplantation among children in the United States: analysis of data from the Organ Procurement and Transplant Network and Extracorporeal Life Support Organization Registry. Circulation. 2011;123(25):2975–84.  https://doi.org/10.1161/.110.991505. Epub.CrossRefPubMedGoogle Scholar
  7. 7.
    Rodriguez-Cruz E, Walters III H, Aggarwal S. Extracorporeal membrane oxygenation. Medscape. n.d. 2016. Available at: http://emedicine.medscape.com/article/1818617-overview?pa=4m5j7y3misjw4spk7vynl6ay0x+cgp6/vasrp+dbkqnmpgojiawq13dl1cs3aqazzoxaisyvxlpgq9sutv7w9gre+tdghihbdbpyiwrvfsa=#a3 (Accessed 26 Sept 2016).
  8. 8.
    Hetzer R, Stiller B. Ventricular assist devices for children. Nat Clin Pract Cardiovasc Med. 2006;3(7):377–86.CrossRefGoogle Scholar
  9. 9.
    Jaquiss RDB, Imamura M. Berlin heart implantation for congenital heart defects. Oper Tech Thorac Cardiovasc Surg. Elsevier Inc; 1. 2016;15(2):162–71.CrossRefGoogle Scholar
  10. 10.
    Kilic A, Nelson K, Scheel J, Ravekes W, Cameron DE, Vricella LA. Outcomes of heart transplantation in small children bridged with ventricular assist devices. Ann Thorac Surg. 2013;96:1420–7.CrossRefGoogle Scholar
  11. 11.
    Hetzer R, Kaufmann F, Delmo Walter EM. Paediatric mechanical circulatory support with Berlin Heart EXCOR: development and outcome of a 23-year experience. Eur J Cardiothorac Surg. 2016;50(2):203–10.  https://doi.org/10.1093/ejcts/ezw011.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Guilherme Henrique Ribeiro de Carvalho
    • 1
    Email author
  • Vanessa Lopes Vieira
    • 1
  • Leandro Pedro Goloni Bertollo
    • 1
  • Fabio Biscegli Jatene
    • 1
  • Luiz Fernando Caneo
    • 1
  1. 1.Faculty of Medicine of University of São Paulo (FMUSP)São PauloBrazil

Personalised recommendations