Ventricular Assist Device Treatment for Pediatric Patients

Continuous-flow ventricular assist devices (CF-VAD) have been widely used in end-stage heart failure in adult patients for both bridge to transplantation and destination therapy. Technology improvement has enabled miniaturization of the CF-VAD, which may greatly benefit the pediatric patients with sufficient body size in advanced heart failure. There are still, however, challenging situations for CF-VAD implantation, such as in single ventricle physiology, anatomically abnormal heart, small children and infants. Limited number of reports of CF-VAD for systemic ventricular failure of Fontan circulation were published. There is, so far, no agreed consensus as for the timing of CF-VAD implantation in such a situation. Successful CF-VAD experiences in (congenitally corrected) transposition of great arteries have been also reported. Berlin Heart EXCOR pediatric is an only device which is suitable for small children and infants. There are more than 1800 implantations reported worldwide. One year overall survival rate is 73%. Dilated cardiomyopathy is the major cause of its use, comprising 53%, and 21% for congenital heart disease. EXCOR pediatric was approved in 2015 in Japan. 28 implants were performed including trial cases. Fifteen patients underwent heart transplantation, 3 weaned from the VAD and 10 on-going support, which means there is no death. Clinical trial of pediatric Jarvik is just about being started with great expectations.