The little ones are catching up-mechanical circulatory support with a pulsatile pneumatic ventricular assist device.

Abstract

It has been a little over 3 decades since the first child, 8 years old, was bridged to heart transplantation with an adult-sized Berlin Heart EXCOR ventricular assist device (VAD) (Berlin Heart AG, Berlin, Germany) with a ventricle of 50 ml of stroke volume. This 27-kg bodyweight boy suffered from terminal heart failure and life-threatening ventricular tachycardia, the sequelae of a congenital heart defect. With the EXCOR, cardiogenic shock could be reversed and after no more than an 8-day waiting period on the pump, orthotopic heart transplantation was successful [1]. During the following year, this pump underwent miniaturization with 25/30-ml pumps fitting children above 15 kg bodyweight. This was the kick-off for multiple support in children, first reported in those with fulminant myocarditis: in the mid-1990s, the outcome of fulminant myocarditis with cardiogenic shock was poor. With the artificial replacement of heart function in 4 previously healthy children suffering from myocarditis with low cardiac output and multiorgan failure, the temporary support with biventricular assist devices (BVAD) was lifesaving for all 4 [2]. We learned during those years that prolonged VAD support was an effective method not only in adults but also in children.