title: Modified TandemHeart ventricular assist device for infant and pediatric circulatory support.
abstract: OBJECTIVE
  The development of pediatric ventricular assist device (VAD) circuits with lower flow ranges for infants and small children is ongoing. We present our results with modifying a readily available adult VAD to support the pediatric population.
  
  
  METHODS
  The TandemHeart VAD (CardiacAssist, Pittsburgh, PA) circuit was modified to include a variable restrictive recirculation shunt to permit lower flow ranges in small pediatric patients.
  
  
  RESULTS
  Initial benchtop flow rates and pressures were studied. Hemolysis trials were performed using whole bovine blood to compare plasma-free hemoglobin levels between modified and unmodified VAD circuits. The modified VAD was surgically implanted in 7 piglets (6 to 14 kg) and which supported them for 4 hours. Levels of hemolysis did not increase and full hemodynamic support was achieved. The modified TandemHeart VAD with a recirculation shunt was subsequently implanted in 2 pediatric patients who were bridged to transplant successfully.
  
  
  CONCLUSIONS
  Because of its simplicity, availability, low prime volume, greater patient flow range, and lower cost, the modified TandemHeart VAD with a recirculation shunt should be considered as an alternative to extracorporeal membrane oxygenation and other pulsatile VADs in children.
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: bkulat@luriechildrens.org.
authors.forename: Bradley
authors.initials: B
authors.lastname: T Kulat
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Hyde M
authors.initials: HM
authors.lastname: Russell
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Sarwark
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Neale
authors.initials: N
authors.lastname: R Zingle
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Moss
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Mongé
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Carl L
authors.initials: CL
authors.lastname: Backer
mesh_terms: D000818:Animals; D002417:Cattle; D002675:Child, Preschool; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D013552:Swine