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Ecmo/VAD in Pediatrics

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By Javier Castro Heart Failure And Heart Transplantation
https://www.readbyqxmd.com/read/27490595/ventricular-assist-devices-in-pediatric-cardiac-intensive-care
#1
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
https://www.readbyqxmd.com/read/27009672/supporting-pediatric-patients-with-short-term-continuous-flow-devices
#2
Jennifer Conway, Mohammed Al-Aklabi, Don Granoski, Sunjidatul Islam, Lyndsey Ryerson, Vijay Anand, Gonzalo Guerra, Andrew S Mackie, Ivan Rebeyka, Holger Buchholz
BACKGROUND: Short-term continuous-flow ventricular assist devices (STCF-VADs) are increasingly being used in the pediatric population. However, little is known about the outcomes in patients supported with these devices. METHODS: All pediatric patients supported with a STCF-VAD, including the Thoratec PediMag or CentriMag, or the Maquet RotaFlow, between January 2005 and May 2014, were included in this retrospective single-center study. RESULTS: Twenty-seven patients (15 girls [56%]) underwent 33 STCF-VAD runs in 28 separate hospital admissions...
May 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27009673/outcomes-of-children-implanted-with-ventricular-assist-devices-in-the-united-states-first-analysis-of-the-pediatric-interagency-registry-for-mechanical-circulatory-support-pedimacs
#3
Elizabeth D Blume, David N Rosenthal, Joseph W Rossano, J Timothy Baldwin, Pirooz Eghtesady, David L S Morales, Ryan S Cantor, Jennifer Conway, Angela Lorts, Christopher S Almond, David C Naftel, James K Kirklin
BACKGROUND: Use of mechanical circulatory support in children has increased as more options have become available. A national account of the use of mechanical support in children and adolescents is essential to understanding outcomes, refining patient selection and improving quality of care. METHODS: The Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) is a National Heart, Lung, and Blood Institute-supported nationwide registry for temporary and durable ventricular assist device (VAD) use in patients <19 years of age...
May 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/26919182/heartware-hvad-for-biventricular-support-in-children-and-adolescents-the-stanford-experience
#4
Mary Lyn Stein, Justin Yeh, Olaf Reinhartz, David N Rosenthal, Beth D Kaufman, Chris S Almond, Seth A Hollander, Katsuhide Maeda
Despite increasing use of mechanical circulatory support in children, experience with biventricular device implantation remains limited. We describe our experience using the HeartWare HVAD to provide biventricular support to three patients and compare these patients with five patients supported with HeartWare left ventricular assist device (LVAD). At the end of the study period, all three biventricular assist device (BiVAD) patients had been transplanted and were alive. LVAD patients were out of bed and ambulating a median of 10...
September 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/26890085/patient-centered-care-for-left-ventricular-assist-device-therapy-current-challenges-and-future-directions
#5
Khadijah Breathett, Larry A Allen, Amrut V Ambardekar
PURPOSE OF REVIEW: Discuss the current status and obstacles that need to be overcome in the future to provide patient-centered care with left ventricular assist device (LVAD) therapy. RECENT FINDINGS: LVADs offer both longer survival and improvements in quality of life for carefully selected patients with inotrope-dependent heart failure. Yet, this technology does not come without significant risk of adverse effects and burdens. Recent observational data comparing LVAD with medical therapy in ambulatory, noninotrope-dependent patients with advanced heart failure suggest that survival may be similar and changes in quality of life may depend on baseline status...
May 2016: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/26793341/pediatric-ventricular-assist-devices
#6
REVIEW
Iki Adachi, Sarah Burki, Farhan Zafar, David Luis Simon Morales
The domain of pediatric ventricular assist device (VAD) has recently gained considerable attention. Despite the fact that, historically, the practice of pediatric mechanical circulatory support (MCS) has lagged behind that of adult patients, this gap between the two groups is narrowing. Currently, the Berlin EXCOR VAD is the only pediatric-specific durable VAD approved by the U.S Food and Drug Administration (FDA). The prospective Berlin Heart trial demonstrated a successful outcome, either bridge to transplantation (BTT), or in rare instances, bridge to recovery, in approximately 90% of children...
December 2015: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/26547402/hospital-costs-for-neonates-and-children-supported-with-extracorporeal-membrane-oxygenation
#7
David Faraoni, Viviane G Nasr, James A DiNardo, Ravi R Thiagarajan
OBJECTIVE: To assess the characteristics associated with high hospital cost for patients receiving extracorporeal membrane oxygenation (ECMO) to identify a cohort of high-resource users. STUDY DESIGN: Cost for hospitalization, during which ECMO support was used, was calculated from hospital charges reported in the 2012 Health Care Cost and Use Project Kid's Inpatient Database. Patients were categorized into 6 diagnostic groups: (1) cardiac surgery; (2) nonsurgical heart disease; (3) congenital diaphragmatic hernia; (4) neonatal respiratory failure; (5) pediatric respiratory failure; and (6) sepsis...
February 2016: Journal of Pediatrics
https://www.readbyqxmd.com/read/26599739/prothrombin-complex-concentrate-and-methylene-blue-for-treatment-of-coagulopathy-and-vasoplegia-in-a-pediatric-heart-transplant-patient
#8
Jennifer K Lee, Caleb Ing
Ventricular assist devices (VADs) are associated with conditions that may complicate the perioperative course of pediatric heart transplants. A 7-year-old girl with dilated cardiomyopathy supported by a Toyobo-NCVC left VAD (Toyobo-National Cardiovascular Center, Osaka, Japan), a pulsatile extracorporeal device, and preoperatively anticoagulated with warfarin presented for orthotopic heart transplant. The course was complicated by persistent bleeding treated with prothrombin complex concentrate and refractory postbypass vasoplegia treated with methylene blue...
March 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/26125664/prevalence-of-warfarin-genotype-polymorphisms-in-patients-with-mechanical-circulatory-support
#9
Morcos Awad, Lawrence S C Czer, Camelia Soliman, James Mirocha, Andrea Ruzza, Joshua Pinzas, Kelsey Rihbany, David Chang, Jaime Moriguchi, Danny Ramzy, Fardad Esmailian, Jon Kobashigawa, Francisco Arabia
Polymorphisms for VKORC1 and CYP2C9 are associated with increased warfarin sensitivity. The prevalence of these polymorphisms in patients with mechanical circulatory support (MCS) is unknown. Polymorphisms for VKORC1 and CYP2C9 were determined in 65 patients undergoing MCS surgery. Postoperative warfarin dose, international normalized ratio (INR), and bleeding events were measured until discharge, 6 months, or composite end point (in-hospital MCS recovery, heart transplant, or death). A total of 67.7% (44/65) had at least one polymorphism: VKORC1 (44...
July 2015: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/26267741/right-ventricular-failure-after-left-ventricular-assist-devices
#10
REVIEW
Brent C Lampert, Jeffrey J Teuteberg
Most patients with advanced systolic dysfunction who are assessed for a left ventricular assist device (LVAD) also have some degree of right ventricular (RV) dysfunction. Hence, RV failure (RVF) remains a common complication of LVAD placement. Severe RVF after LVAD implantation is associated with increased peri-operative mortality and length of stay and can lead to coagulopathy, altered drug metabolism, worsening nutritional status, diuretic resistance, and poor quality of life. However, current medical and surgical treatment options for RVF are limited and often result in significant impairments in quality of life...
September 2015: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/26347873/late-complications-following-continuous-flow-left-ventricular-assist-device-implantation
#11
REVIEW
Joshua C Grimm, J Trent Magruder, Clinton D Kemp, Ashish S Shah
Left ventricular assist devices have become standard therapy for patients with end-stage heart failure. They represent potential long-term solutions for a growing public health problem. However, initial enthusiasm for this technology has been tempered by challenges posed by long-term support. This review examines these challenges and out current understanding of their etiologies.
2015: Frontiers in Surgery
https://www.readbyqxmd.com/read/26281035/advances-in-mechanical-assist-devices-and-artificial-hearts-for-children
#12
REVIEW
James K Kirklin
PURPOSE OF REVIEW: Mechanical circulatory support (MCS) has rapidly evolved toward continuous flow technology in adults. In the pediatric population, the Berlin EXCOR, a paracorporeal pulsatile pump, is the only MCS device specifically approved for pediatric use. The current era of pediatric MCS includes an increasing application of adult continuous flow pumps to pediatric patients. RECENT FINDINGS: The Berlin EXCOR pulsatile pump has been studied in over 200 patients...
October 2015: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/26262463/pediatric-mechanical-circulatory-support-available-devices-and-outcomes-as-bridge-to-transplant-therapy
#13
REVIEW
Angela Lorts, Elizabeth D Blume
PURPOSE OF REVIEW: The use of mechanical circulatory support in children has increased dramatically over the current decade. A review of the pediatric ventricular assist device (VAD) literature is timely and relevant in order to improve outcomes and refine patient selection as new devices become available and current VADs are used in smaller patients. RECENT FINDINGS: Outcomes of pediatric patients bridged to transplant with VAD therapy continue to improve. Patient selection in children continues to be complex as size and anatomy make decision-making unique from the adult practice...
October 2015: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/26147841/ventricular-assist-device-in-single-ventricle-heart-disease-and-a-superior-cavopulmonary-anastomosis
#14
Robert A Niebler, Tejas K Shah, Michael E Mitchell, Ronald K Woods, Steven D Zangwill, James S Tweddell, Stuart Berger, Nancy S Ghanayem
Our objective is to describe the use of a ventricular assist device (VAD) in single-ventricle patients with circulatory failure following superior cavopulmonary anastomosis (SCPA). We performed a retrospective chart review of all single-ventricle patients supported with a VAD following SCPA. Implantation techniques, physiologic parameters while supported, medical and surgical interventions postimplant, and outcomes were reviewed. Four patients were supported with an EXCOR Pediatric (Berlin Heart Inc., The Woodlands, TX, USA) following SCPA for a median duration of 10...
February 2016: Artificial Organs
https://www.readbyqxmd.com/read/26210751/ventricular-assist-devices-in-a-contemporary-pediatric-cohort-morbidity-functional-recovery-and-survival
#15
Mary Lynette Stein, Duy T Dao, Lan N Doan, Olaf Reinhartz, Katsuhide Maeda, Seth A Hollander, Justin Yeh, Beth D Kaufman, Christopher S Almond, David N Rosenthal
BACKGROUND: Limited availability of donor organs has led to the use of ventricular assist devices (VADs) to treat heart failure in pediatric patients, primarily as bridge to transplantation. How effective VAD therapy is in promoting functional recovery in children is currently not known. METHODS: We report morbidity and mortality as defined by the Interagency Registry for Mechanically Assisted Circulatory Support Modified for Pediatrics (PediMACS) and the use of the Treatment Intensity Score to assess functional status for 50 VAD patients supported at a single pediatric program from 2004 to 2013...
January 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/26234922/tissue-plasminogen-activator-treatment-of-bilateral-pulmonary-emboli-in-a-pediatric-patient-supported-with-a-ventricular-assist-device
#16
Justin Godown, Debra A Dodd, Thomas P Doyle, Andrew H Smith, Dana Janssen, Bret A Mettler
Bleeding and thrombosis are well-known potential complications of VAD support. We present a pediatric patient who developed massive bilateral pulmonary emboli while on BiVAD support that was successfully treated with intravenous tPA and bridged to heart transplant.
November 2015: Pediatric Transplantation
https://www.readbyqxmd.com/read/26123952/the-ethics-of-risk-and-innovation
#17
EDITORIAL
Heather J Ross
No abstract text is available yet for this article.
January 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/26087668/assessment-of-patients-and-caregivers-informational-and-decisional-needs-for-left-ventricular-assist-device-placement-implications-for-informed-consent-and-shared-decision-making
#18
Jennifer S Blumenthal-Barby, Kristin M Kostick, Estevan D Delgado, Robert J Volk, Holland M Kaplan, L A Wilhelms, Sheryl A McCurdy, Jerry D Estep, Matthias Loebe, Courtenay R Bruce
BACKGROUND: Several organizations have underscored the crucial need for patient-centered decision tools to enhance shared decision-making in advanced heart failure. The purpose of this study was to investigate the decision-making process and informational and decisional needs of patients and their caregivers regarding left ventricular assist device (LVAD) placement. METHODS: In-depth, structured interviews with LVAD patients, candidates and caregivers (spouse, family members) (n = 45) were conducted...
September 2015: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/26039437/extubation-during-pediatric-extracorporeal-membrane-oxygenation-is-it-always-safe
#19
LETTER
Matteo Di Nardo, Nicola Pirozzi, Antonio Pesenti
No abstract text is available yet for this article.
June 2015: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/26049415/-awake-veno-arterial-extracorporeal-membrane-oxygenation-in-pediatric-cardiogenic-shock-a-single-center-experience
#20
F Schmidt, T Jack, M Sasse, T Kaussen, H Bertram, A Horke, K Seidemann, P Beerbaum, H Koeditz
In pediatric patients with acute refractory cardiogenic shock (CS), extracorporeal membrane oxygenation (ECMO) remains an established procedure to maintain adequate organ perfusion. In this context, ECMO can be used as a bridging procedure to recovery, VAD or transplantation. While being supported by ECMO, most centers tend to keep their patients well sedated and supported by invasive ventilation. This may be associated with an increased risk of therapy-related morbidity and mortality. In order to optimize clinical management in pediatric patients with ECMO therapy, we report our strategy of veno-arterial ECMO (VA-ECMO) in extubated awake and conscious patients...
December 2015: Pediatric Cardiology
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