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Pediatric vad

Roosevelt Bryant, Farhan Zafar, Chesney Castleberry, John L Jefferies, Angela Lorts, Clifford Chin, David L S Morales
The Berlin Heart EXCOR pediatric ventricular assist device is approved by the FDA for bridge to cardiac transplantation (BTT) in children. As the clinical outcomes of the EXCOR continue to be evaluated in the U.S., data on post transplant survival are needed. The UNOS database was used to identify patients < 18 years old undergoing orthotopic heart transplantation (OHT) from 6/2004 to 6/2014. Patients undergoing BTT with the EXCOR were identified. A matched cohort of (358) patients undergoing OHT without pre-transplant mechanical circulatory support (no-MCS) was also identified as controls...
September 20, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
James H Hertzog, Thomas E Pearson, Marc A Priest, Ellen Spurrier, Ryan R Davies
Ventricular assist devices (VADs) for the mechanical support of cardiac failure are being used more frequently in children of increasingly younger age. These children have significant and multiple medical comorbidities, and their length of hospital stay has been increasing. As this population of hospitalized VAD-supported children increases, so does the possibility of their need for interfacility transport for specialized diagnostic or therapeutic procedures. Reports on such transports are limited to 3 children who underwent scheduled elective transfers...
September 2016: Air Medical Journal
Nathan Gossai, Nicholas M Brown, Rebecca Ameduri, Nicole D Zantek, James St Louis, Marie E Steiner
BACKGROUND: The balance of hemostasis and anticoagulation is a concern for patients dependent upon ventricular assist devices (VADs). Bleeding is a common complication with both short- and long-term use of these devices. A better understanding of the risk factors and etiologies of bleeding associated with these devices is needed and could improve the overall results. We sought to determine the relationship of mechanical circulatory assist device use with acquired von Willebrand disease (avWD) in children...
September 2016: World Journal for Pediatric & Congenital Heart Surgery
Marie E Steiner, Lisa R Bomgaars, M Patricia Massicotte
Efficacious ventricular assist device (VAD) support in pediatric patients depends on successful antithrombotic management. The experience with antithrombotic management for the EXCOR® Pediatric VAD Investigational Device Exemption (IDE) study is described. All 68 children in North America enrolled in the IDE study May 9, 2007 to December 10, 2010 are included. The Edmonton Anticoagulation and Platelet Inhibition Protocol was provided for management guidance. Monitoring parameters, drug dosing, targeted serious adverse events and pump changes were reviewed...
August 22, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Jonathan Byrnes, Chet Villa, Angela Lorts
OBJECTIVES: The objectives of this review are to discuss the process of patient and mechanical device selection, operative management, and postoperative care with a focus on the management of right ventricular failure, anticoagulation strategies, device-related infections and neurologic sequelae. DATA SOURCES: MEDLINE, PubMed. CONCLUSION: The number of patients with advanced heart failure due to either acquired or congenital heart disease continues to increase, necessitating in some mechanical circulatory support and in others cardiac transplantation...
August 2016: Pediatric Critical Care Medicine
Arianna Di Molfetta, Sergio Filippelli, Gianfranco Ferrari, Aurelio Secinaro, Krystzof Zielinski, Antonio Amodeo
A 2-year-old child was implanted with an Berlin Heart EXCOR Ventricular Assist Device (Berlin Heart, Berlin, Germany) as a bridge to heart transplantation for idiopathic dilated cardiomyopathy. At postoperative day 296, a significant reduction of membrane movement was observed. The device was explanted and tested on a hydronumerical circulation simulator. Findings suggested that the integrity of the multilayered membrane had been compromised. This was confirmed by a computed tomography scan of the device. The computed tomography evidenced a detachment of the 3-layered membrane, with a thinner, convex layer on the side of the air chamber and an opposite convexity of the remaining membranes...
August 2016: Annals of Thoracic Surgery
Michael T Griffin, Matthew F Grzywinski, Hannah J Voorhees, Marina V Kameneva, Salim E Olia
To address the challenge of unloading the left ventricle during pediatric mechanical circulatory support using next-generation rotary blood pumps, a novel inflow cannula was developed. This unique inflow cannula for pediatric, continuous-flow, left ventricular assist devices (VADs) with a parabolic-shaped inlet entrance was evaluated alongside a bevel-tip and fenestrated-tip cannula via an ex vivo, isolated-heart experimental setup. Performance was characterized using two clinical scenarios of over-pumping and hypovolemia, created by varying pump speed and filling preload pressure, respectively, at ideal and off-axis cannula placement to assess ventricular unloading and positional sensitivity...
September 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Bryan C Good, Steven Deutsch, Keefe B Manning
No abstract text is available yet for this article.
July 6, 2016: Cardiovascular Engineering and Technology
Adam C Adler, Ramesh Kodavatiganti
Kawasaki disease, although common in children, may rarely affect the coronary arteries, leading to aneurysm formation and potential for coronary thrombus formation. Extremely rarely, coronary aneurysms from Kawasaki disease can thrombose, resulting in ischemic myocardium. We present a case of a 31-month-old patient requiring a left ventricular assist device after thrombosis of giant coronary aneurysms led to ischemic cardiomyopathy. At the termination of the surgical procedure, we encountered 2 periods of ventricular assist device dropout requiring intervention...
August 15, 2016: A & A Case Reports
Michael C Mongé, Bradley T Kulat, Osama Eltayeb, Shyamasundar Balasubramanya, Anne E Sarwark, Neale R Zingle, Steven T Moss, Michael Alice Moga, Jeffrey G Gossett, Elfriede Pahl, John M Costello, Carl L Backer
BACKGROUND: A continuous-flow "adult" ventricular assist device (VAD) was modified to support infants and children waiting for heart transplantation. METHODS: A centrifugal VAD, designed to flow at 1.5 to 8 L/min, was used as a bridge to transplantation in pediatric patients. In smaller children and infants, a modified recirculation shunt permitted lower flow ranges. In hypoxic patients, an oxygenator was spliced into the circuit. RESULTS: From 2010 to 2015, the VAD was placed in 13 consecutive patients...
July 2016: Annals of Thoracic Surgery
Melissa K Webb, Jian Wang, Matthew S Riegel, Kristine J Guleserian, Joseph M Forbess, Thomas M Zellers, V Vivian Dimas
OBJECTIVE: This study's objective was to evaluate insertion techniques and device fit of the pediatric version of the Impella ventricular assist device in swine which had similar sized carotids and left ventricles (LVs) as children weighing 10-20 kg. BACKGROUND: Options for minimally invasive circulatory support in children are limited. A modified device based on the current Impella 2.5 platform was created in an effort to provide minimally invasive circulatory support for children...
May 24, 2016: Catheterization and Cardiovascular Interventions
Magdy M El-Sayed Ahmed, Melissa B Jones, Joshua P Kanter, Steven Boyce, Richard A Jonas, Janet Scheel, Pranava Sinha
We present a hybrid technique of left ventricular assist device exclusion after bridge to recovery in a pediatric patient, using percutaneous occlusion of the outflow graft and surgical excision of driveline. This technique has the advantage of avoiding chest reentry and cardiopulmonary bypass.
June 2016: Annals of Thoracic Surgery
David N Rosenthal, Christopher S Almond, Robert D Jaquiss, Christine E Peyton, Scott R Auerbach, David R Morales, Deirdre J Epstein, Ryan S Cantor, Robert L Kormos, David C Naftel, Ryan J Butts, Nancy S Ghanayem, James K Kirklin, Elizabeth D Blume
BACKGROUND: Ventricular assist devices (VADs) have been used in children on an increasing basis in recent years. One-year survival rates are now >80% in multiple reports. In this report we describe adverse events experienced by children with durable ventricular assist devices, using a national-level registry (PediMACS, a component of INTERMACS) METHODS: PediMACS is a national registry that contains clinical data on patients who are <19 years of age at the time of VAD implantation...
May 2016: Journal of Heart and Lung Transplantation
Seth A Hollander, David M Axelrod, Daniel Bernstein, Harvey J Cohen, Barbara Sourkes, Sushma Reddy, David Magnus, David N Rosenthal, Beth D Kaufman
Despite greatly improved survival in pediatric patients with end-stage heart failure through the use of ventricular assist devices (VADs), heart failure ultimately remains a life-threatening disease with a significant symptom burden. With increased demand for donor organs, liberalizing the boundaries of case complexity, and the introduction of destination therapy in children, more children can be expected to die while on mechanical support. Despite this trend, guidelines on the ethical and pragmatic issues of compassionate deactivation of VAD support in children are strikingly absent...
May 2016: Journal of Heart and Lung Transplantation
Marlene Speth, Frank Münch, Ariawan Purbojo, Martin Glöckler, Okan Toka, Robert A Cesnjevar, André Rüffer
This study reports a single-centre experience of the Medos Deltastream diagonal-pump (DP3) for extracorporeal cardiac, pulmonary, or combined support in a single-center pediatric cohort. Twenty-seven consecutive patients with 28 runs of the DP3 between January 2013 and June 2014 were included for analysis. Median patient age, weight, and duration of support were 278 days (range: 0 days-14.2 years), 7.2 kg (range: 2.5-39 kg), and 8 days (range: 2-69 days). Midline sternotomy (n = 20, 71.4%) or cervical approaches (n = 8, 28...
July 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Eugene C DePasquale, Richard K Cheng, Mario C Deng, Ali Nsair, William J McKenna, Gregg C Fonarow, Daniel L Jacoby
BACKGROUND: Outcomes of arrhythmogenic right ventricular cardiomyopathy (ARVC) patients after heart transplantation have not been well studied. Diagnostic criteria were established in 1994 and subsequently revised in 2010. We sought to better characterize this population in a national cohort. METHODS: A total of 35,138 heart transplant-only recipients were identified from the United Network for Organ Sharing (UNOS) Thoracic Registry (1994-2011); 73 had ARVC. The non-ARVC group included ischemic cardiomyopathy, restrictive cardiomyopathy, dilated cardiomyopathy, hypertrophic cardiomyopathy, and other...
May 3, 2016: Journal of Cardiac Failure
Korhan Erkanlı, Mehmet Kaya, Murat Avşar, İhsan Bakır
Ventricular assist devices are implanted in patients with intractable heart failure as a bridge to cardiac transplantation to support the circulatory system mechanically. We present a report of a continuous flow ventricular assist device successfully placed as a bridge to transplantation in the intrapericardium of a petite-sized child with a BSA of 0.56 m2. Not only is the use of an intrapericardial, continuous-flow, centrifugal pump feasible for destination therapy, but also for low-weight pediatric patients with end-stage heart failure as a bridge to transplantation when there is chronic shortage of donor organs for heart transplantation...
2016: Heart Surgery Forum
Katie H Faella, David Whiting, Francis Fynn-Thompson, Gregory S Matte
The direct thrombin inhibitor bivalirudin is an option for anticoagulation in patients with heparin induced thrombocytopenia (HIT) requiring cardiopulmonary bypass (CPB). There are a limited number of reports of pediatric patients in which bivalirudin has been used for anticoagulation for CPB. We present the case of an 11 year old male with acute onset heart failure secondary to idiopathic dilated cardiomyopathy that developed heparin induced thrombocytopenia with thrombosis (HITT). The patient was anticoagulated in the operating room with bivalirudin and placed on CPB for insertion of a HeartWare(®) Ventricular Assist Device (Heartware(®))...
March 2016: Journal of Extra-corporeal Technology
Ed Peng, Richard Kirk, Neil Wrightson, Phuoc Duong, Lee Ferguson, Massimo Griselli, Tanveer Butt, John J O'Sullivan, Guy A MacGowan, David Crossland, Stephan Schueler, Asif Hasan
BACKGROUND: Mechanical circulatory support in the pediatric population is currently limited to pulsatile ventricular assist devices (VAD). In recent years, the use of durable, newer generation, continuous flow devices have increased substantially among adults with end-stage heart failure. We examined the extended role of this device in the pediatric population (aged less than 18 years). METHODS: Between 2010 and 2015, 12 patients (median age 7.1 years; range, 3...
August 2016: Annals of Thoracic Surgery
Chesney Castleberry, Farhan Zafar, Tamara Thomas, Muhammad S Khan, Roosevelt Bryant, Clifford Chin, David L S Morales, Angela Lorts
Patients supported with a VAD are at increased risk for sensitization. We aimed to determine risk factors for sensitization as well as the impact of sensitization on post-transplant outcomes. The UNOS database (January 2004-June 2014) was used to identify patients (≤18 yrs) supported with a durable VAD. Rates and degree of sensitization in the VAD cohort were calculated. Post-transplant survival was determined comparing outcomes of sensitized vs. non-sensitized patients. There were 3097 patients included in the study; 19% (n = 579) were bridged with a VAD...
June 2016: Pediatric Transplantation
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