title: Left ventricular assist device support as a bridge to recovery in young children.
abstract: OBJECTIVE
  Left ventricular assist device (LVAD) experience and follow-up data in children are limited. We report the deployment and successful weaning from LVAD in young children with severe heart failure (HF).
  
  
  METHODS
  From 2004--2009, 13 children suffering from HF were placed on LVAD. All presented with a dilated left ventricle (LV) with severely reduced contractility, secondary to myocarditis, atrial arrhythmia or idiopathic HF. This study reports their outcomes and longitudinal follow-up.
  
  
  RESULTS
  Of 13 young children with HF (ages 1 month--6 years; mean 19.2 months) placed on LVAD: eight weaned to recovery and successful hospital discharge, one was transplanted and four died. Echo follow-up in the weaned patients (mean age 22.1 months) revealed significant improvements from pre-LVAD measurements: LV end-diastolic dimension (LVED) mean z-score decreased from +4.8 to +0.95 (P < .001); fractional shortening (FS %) improved from a mean of 9.3% to 33% (P < .001); and the degree of mitral regurgitation (MR) significantly improved (P < .05). Time to LVAD deployment from HF diagnosis was more likely to be less than 30 days in the successfully weaned patients (100%) than patients who died or were transplanted (20%); P = .007.
  
  
  CONCLUSIONS
  LVAD support can be utilized as a bridge to recovery in young children with HF. Following LVAD weaning, children sustain improvements in LV size, function and degree of MR. LVAD deployment less than 30 days from HF diagnosis improves the likelihood of successful weaning and illustrates that children with acute etiologies of HF are more likely to achieve recovery.
authors.affiliation: Departments of Pediatrics, University of Arizona, College of Medicine, Tucson, AZ 85724, USA.
authors.forename: Chelsea L
authors.initials: CL
authors.lastname: Ihnat
authors.forename: Hannah
authors.initials: H
authors.lastname: Zimmerman
authors.forename: Jack G
authors.initials: JG
authors.lastname: Copeland
authors.forename: F John
authors.initials: FJ
authors.lastname: Meaney
authors.forename: Richard E
authors.initials: RE
authors.lastname: Sobonya
authors.forename: Brandon T
authors.initials: BT
authors.lastname: Larsen
authors.forename: Brian
authors.initials: B
authors.lastname: Blair
authors.forename: Daniela
authors.initials: D
authors.lastname: Lax
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Barber
mesh_terms: D001130:Arizona; D002648:Child; D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D010351:Patient Discharge; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left