title: Supporting pediatric patients with short-term continuous-flow devices.
abstract: Short-term continuous-flow ventricular assist devices (STCF-VADs) are increasingly being used in the pediatric population. However, little is known about the outcomes in patients supported with these devices.
  
  
  
  All pediatric patients supported with a STCF-VAD, including the Thoratec PediMag or CentriMag, or the Maquet RotaFlow, between January 2005 and May 2014, were included in this retrospective single-center study.
  
  
  
  Twenty-seven patients (15 girls [56%]) underwent 33 STCF-VAD runs in 28 separate hospital admissions. The STCF-VAD was implanted 1 time in 23 patients (85%), 2 times in 2 patients (7%), and 3 times in 2 patients (7%). Implantation occurred most commonly in the context of congenital heart disease in 14 runs (42.2%), cardiomyopathy in 11 (33%), and after transplant in 6 (18%). The median age at implantation was 1.7 (interquartile range [IQR] 0.1, 4.1) years, and median weight was 8.9 kg (IQR 3.7, 18 kg). Patients were supported for a median duration of 12 days (IQR 6, 23 days) per run; the longest duration was 75 days. Before implantation, 15 runs (45%) were supported by extracorporeal membrane oxygenation (ECMO). After implantation, an oxygenator was required in 20 runs (61%) and continuous renal replacement therapy in 21 (64%). Overall, 7 runs (21%) resulted in weaning for recovery, 14 (42%) converted to a long-term VAD, 4 (12%) resulted in direct transplantation, 3 (9%) were converted to ECMO, and 5 (15%) runs resulted in death on the device or within 1 month after decannulation. The most common complication was bleeding requiring reoperation in 24% of runs. In addition, 18% of runs were associated with neurologic events and 15% with a culture-positive infection. Hospital discharge occurred in 19 of 28 STCF-VAD admissions (67%). In follow-up, with a median duration of 9.2 months (IQR 2.3, 38.3 months), 17 patients (63%) survived.
  
  
  
  STCF-VADs can successfully bridge most pediatric patients to recovery, long-term device, or transplant, with an acceptable complication profile. Although these devices are designed for short-term support, longer support is possible and may serve as an alternative approach to patients not suitable for the current long-term devices.
authors.affiliation: Division of Cardiology, Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada. Electronic address: jennifer.conway2@albertahealthservices.ca.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Conway
authors.affiliation: Division of Pediatric Cardiac Surgery, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Aklabi
authors.affiliation: Divisions of Division of Pediatric Critical Care, Cardiac Surgery; Stollery Children's Hospital, Pediatric Cardiac Critical Care, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Don
authors.initials: D
authors.lastname: Granoski
authors.affiliation: Division of Cardiology, Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sunjidatul
authors.initials: S
authors.lastname: Islam
authors.affiliation: Divisions of Division of Pediatric Critical Care, Cardiac Surgery.
authors.forename: Lyndsey
authors.initials: L
authors.lastname: Ryerson
authors.affiliation: Divisions of Division of Pediatric Critical Care, Cardiac Surgery.
authors.forename: Vijay
authors.initials: V
authors.lastname: Anand
authors.affiliation: Divisions of Division of Pediatric Critical Care, Cardiac Surgery.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Guerra
authors.affiliation: Division of Cardiology, Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Mackie
authors.affiliation: Division of Pediatric Cardiac Surgery, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Ivan
authors.initials: I
authors.lastname: Rebeyka
authors.affiliation: Division of Pediatric Cardiac Surgery, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Holger
authors.initials: H
authors.lastname: Buchholz
mesh_terms: D009202:Cardiomyopathies; D002648:Child; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006330:Heart Defects, Congenital; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: CentriMag; PediMag; RotaFlow; continuous-flow; pediatric patients; short-term support; ventricular assist device