title: Ventricular assist device implantation in the pediatric population: does pump size selection and associated hemodynamics impact outcomes?
abstract: The use of pediatric ventricular assist devices (VADs) continues to evolve with the availability of smaller blood pumps. We examine the correlation of implanting appropriate sized blood pumps with a lower incidence of VAD related complications (VADRC). A 7-year retrospective review was undertaken for all pediatric VAD patients. Optimal VAD hemodynamics were defined as cardiac index of 2.7 L/m2 and rate of 80 beats per minute (bpm) with complete fill/empty of the blood pump. Patient/blood pump size match, VAD rate and fill/empty ratios were calculated (optimum = 1.0) and then correlated with incidence of VADRC. The study included 22 patients, mean age 9.77 years (6 mo-18 yrs) and mean body surface area (BSA) of 1.14 m2 (0.14 m2-2.32 m2), who underwent VAD implantation. VADRC included death while on support (n = 5), bleeding requiring reoperation (n = 8), hemolysis (n = 2), neurologic events (n = 2), thrombus formation (n = 3), and infection (n = 3). Six patients were bridged to transplant without any VADRC. This subset of patients had a mean blood pump size match ratio of 0.98, VAD rate ratio of 0.92 and fill/empty ratio of 1.00. Patients with VADRC (n = 16) were found to have a mean blood pump size match ratio of 0.72, VAD rate ratio of 0.72 and fill/empty ratio of 0.78. We report a series of pediatric patients with wide ranging BSA receiving VAD implantation. Selection of appropriate sized blood pumps can be correlated with decreased VADRC.
authors.affiliation: Department of Pediatrics, Congenital Heart Center, College of Medicine, University of Florida, Gainesville, Florida, USA. husain_adil@yahoo.com
authors.forename: S Adil
authors.initials: SA
authors.lastname: Husain
authors.forename: Gonzolo
authors.initials: G
authors.lastname: Wallis
authors.forename: Fredrick J
authors.initials: FJ
authors.lastname: Fricker
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bleiweis
authors.forename: Edward D
authors.initials: ED
authors.lastname: Staples
authors.forename: Charles T
authors.initials: CT
authors.lastname: Klodell
authors.forename: John W
authors.initials: JW
authors.lastname: Brown
authors.forename: Mark W
authors.initials: MW
authors.lastname: Turrentine
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D044382:Population Groups; D011474:Prosthesis Design; D011673:Pulsatile Flow; D012189:Retrospective Studies; D016896:Treatment Outcome