title: Ventricular assist device application as a bridge to pediatric heart transplantation: a single center's experience.
abstract: OBJECTIVE
  There are limited options for mechanical circulatory support to treat end-stage heart failure in pediatric patients. Although extracorporeal membrane oxygenation is commonly used in infants and children, ventricular assist devices (VAD) provide a longer duration of support with fewer complications before recovery or as a bridge to heart transplantation (HTx), as described herein.
  
  
  METHODS
  This retrospective chart review of eight patients transplanted from April 2008 to December 2011, after left ventricular assist device (LVAD) implantation due to end-stage heart failure. Their mean age was 12 years (9-15 y) and mean body weight, 48 kg (20-78). All were New York Heart Association functional class IV with mean left ventricular ejection fractions less than 15%.
  
  
  RESULTS
  The six patients (75%) received HTx after a mean LVAD support duration of 43.2 days; 2 (25%) died before a suitable heart became available. Their mean duration of LVAD support was 30 days. There were 4 (50%) who experienced clinically evident thromboembolic events: 3 (37.5%) cerebrovascular with 1 mortality and 1 (12.5%) as acute limb ischemia. Transient hemodialysis was performed in 4 (50%). Bloodstream infection identified in 6 (75%) was controlled with intravenous antibiotics. Driveline infection identified in 4 (50%) was treated successfully with local wound dressing changes and intravenous antibiotics. One 9-year-old boy died of rejection at 16 months after transplantation.
  
  
  CONCLUSIONS
  Because of the organ shortage, pediatric patients have a low chance to undergo HTx. VAD provides long-term support for children with end-stage heart failure before a suitable heart becomes available. A thromboembolic event remains a major complication influencing their survival.
authors.affiliation: Department of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: K H
authors.initials: KH
authors.lastname: Hsu
authors.forename: S C
authors.initials: SC
authors.lastname: Huang
authors.forename: N H
authors.initials: NH
authors.lastname: Chou
authors.forename: N H
authors.initials: NH
authors.lastname: Chi
authors.forename: C I
authors.initials: CI
authors.lastname: Tsao
authors.forename: W J
authors.initials: WJ
authors.lastname: Ko
authors.forename: Y S
authors.initials: YS
authors.lastname: Chen
authors.forename: C I
authors.initials: CI
authors.lastname: Chang
authors.forename: I S
authors.initials: IS
authors.lastname: Chiu
authors.forename: S S
authors.initials: SS
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D013624:Taiwan; D013923:Thromboembolism / Q000209:etiology; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D014850:Waiting Lists