- More than 1/3 patients receiving heart transplants had a ventricular assist device (VAD).
- Less than 10 VADs are implanted per year on average at most hospitals.
Statement Background: VADs and pediatric heart failure
The International Society for Heart and Lung Transplantation (ISHLT) released a consensus statement from top experts in the field regarding the management of pediatric and congenital heart disease (CHD) patients who are on VADs.
The use of VADs is becoming a more prevalent treatment for pediatric heart failure. The 2019 ISHLT registry found more than one-third of patients being transplanted were bridged to transplant with a VAD. While use of VADs increased in the last decade, most hospitals reported implanting less than 10 VADs each year.
The consensus statement was guided by evidence when available, as well as expert opinion due to lack of pediatric-focused literature and research. Scott Auerbach, MD, medical director of the Ventricular Assist Device Program at Children's Hospital Colorado and Kathleen Simpson, MD, heart failure and transplant cardiologist specializing in heart failure in congenital heart disease, participated in the development of the consensus document. The guideline aims to improve outcomes in children with end-stage heart failure and was endorsed by the American Heart Association. Learn more about Children's Colorado's pediatric cardiac surgery outcomes.
Patient selection: timing of VAD
Decision-making for optimal timing of VAD implantation in pediatric patients is a complex choreography of assessing risks and benefits.
- VAD implementation should be considered before significant end-organ dysfunction or clinical deterioration.
- Patients in cardiogenic shock, or INTERMACS Profile 1, have increased mortality rates post VAD. Consider stabilization prior to durable support, such as attempts to reverse shock or using temporary mechanical circulatory support like extracorporeal membrane oxygenation (ECMO) or a paracorporeal continuous-flow device for children with end-organ dysfunction.
Indications for VAD
Failure of medical management
Despite medical management, commonly reported measures of congestion and/or inadequate cardiac output include:
- Progressive respiratory decompensation
- Liver dysfunction
- Kidney injury
- Feeding intolerance
- Elevated pulmonary vascular resistance
- End-organ dysfunction
Post-cardiotomy failure to wean from cardiopulmonary bypass (CPB)
Failure to wean from CPB or decompensation during the index hospitalization after cardiac surgery is a significant risk factor for mortality among patients supported with the Berlin Heart EXCOR.
Intent: VAD strategies
Bridge to transplant
- Primary indication for pediatric VAD in North America
- 55% listed at the time of implantation
Bridge to candidacy or decision
- 34% accessed for candidacy
- Becoming more common in certain patients with:
- Muscular dystrophy (MD)