Thoratec ventricular assist devices in pediatric patients: update on clinical results.
Particularly in pediatric patients, mechanical circulatory support remains a clinical challenge. We analyzed the Stanford experience with use of the Thoratec ventricular assist device (VAD) in children and adolescents and data from the company's voluntary database. Through January 2005, 209 patients up to 18 years of age have been supported with the Thoratec VAD worldwide. Mean age was 14.5 years (range 5-18 years), mean weight was 57 kg (range 17-118 kg), and mean body surface area was 1.6 m2 (range 0.7-2.3 m2). The majority of patients were supported for cardiomyopathies (55%) and acute myocarditis (25%). A minority (6%) was treated for end-stage congenital heart disease. Average duration of support was 44 days (0-434 days). Overall survival to transplantation or weaning off the device was 68%. Survival rates were higher for patients with cardiomyopathies (74%) and acute myocarditis (86%) compared with patients with congenital heart disease (27%). We performed a subanalysis in small children with a body surface area of less 1.3 m2. This subgroup had a higher incidence of congenital heart disease and a slightly lower survival (52%). Aspects of the particular risks and device management in these small patients are discussed.
Reinhartz
Olaf
O
Stanford University, Department of Cardiothoracic Surgery, 300 Pasteur Drive, Stanford, CA 94605, USA.
Hill
J Donald
JD
Al-Khaldi
Abdulaziz
A
Pelletier
Marc P
MP
Robbins
Robert C
RC
Farrar
David J
DJ
D000208:Acute Disease; D000293:Adolescent; D001830:Body Surface Area; D009202:Cardiomyopathies / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000628:therapy; D006333:Heart Failure / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy; D009205:Myocarditis / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States