Ventricular Assist Device Implantation for Infant End-Stage Heart Failure - A Single-Center Experience

Abstract

<h3>Purpose</h3> Ventricular assist device (VAD) application in children is increasing these days. But, there are many challenges to successful clinical outcomes as a bridge to pediatric heart transplantation in young infants. We present our VAD implantation experience in a single center for pediatric end-stage heart failure in the infant. <h3>Methods</h3> We retrospectively reviewed clinical records of pediatric patients (n=10) under one year old who underwent VAD implantation between January 2018 and August 2021. Primary endpoints were heart transplantation, ongoing VAD support, or death. <h3>Results</h3> The median patient age was 11 month-old (239days old) (range: 3-12 month-old). The median BSA was 0.35m² (range: 0.26-0.45). The leading cause of heart failure requiring VAD support was dilated cardiomyopathy (<i>n</i> = 5), restrictive cardiomyopathy (n=1), myocarditis (<i>n</i> = 1), congenital heart disease (<i>n</i> = 2). There were two cases of the majority with INTERMACS Level 1 and 2 at the time of implant. Six patients (66.6%) had Berlin Heart EXCOR® LVAD, whereas four patients underwent BVAD implantation. The median length of HVAD support was 116 days (range 6-186 days). Among the nine patients, survival during VAD therapy to date is 77.7% (7/9), with four (57.1%) bridged to heart transplantation, two (28.5%) continuing to receive support, one recovery of ejection fraction and weaning from VAD support (14.2%). Posttransplant survival has been 100%, with a median follow-up of 509 days (range 353-830). <h3>Conclusion</h3> An active application of VAD implantation can provide excellent pediatric heart failure management results for very young and small end-stage heart failure patients. Further large-scale multicenter registration and standardization of management could improve clinical outcomes for infant patients with VAD.