title: An Extended Role of Continuous Flow Device in Pediatric Mechanical Circulatory Support.
abstract: BACKGROUND
  Mechanical circulatory support in the pediatric population is currently limited to pulsatile ventricular assist devices (VAD). In recent years, the use of durable, newer generation, continuous flow devices have increased substantially among adults with end-stage heart failure. We examined the extended role of this device in the pediatric population (aged less than 18 years).
  
  
  METHODS
  Between 2010 and 2015, 12 patients (median age 7.1 years; range, 3.7 to 17.0; one third of patients were aged 5 years or less) received a HeartWare ventricular assist device (HVAD; HeartWare, Framingham, MA), 11 for cardiomyopathy and 1 for posttransplant rejection. Right VAD support (n = 5; 42%) was provided by a short-term device (Levitronix, Zurich, Switzerland).
  
  
  RESULTS
  Overall, 1 patient died (day 638), 8 patients (67%) underwent transplantation, 1 patient (8.3%) recovered, and 2 patients (17%) remain on HVAD. The mean length of support was 150 days (range, 16 to 638). Four patients (33.3%) were discharged home (all left VAD). In the left VAD group (n = 7), 3 patients subsequently received transplants (days 185, 201, and 234, respectively), 1 recovered (day 149), 1 died (day 638), 1 remained on HVAD (day 198), and 1 needed conversion to biventricular assist device (BIVAD [day 73]). In the BIVAD group (n = 5), right VAD was weaned in 3 (60%), all subsequently received transplants, and 2 remained on BIVAD support until transplant (days 16 and 17, respectively). One BIVAD patient required conversion to central cannulation for longer-term support. Four BIVAD patients (80%) were in Interagency Registry for Mechanically Assisted Circulatory Support level 1 before VAD compared with 2 (29%) in the left VAD group (p = not significant). The actuarial survival rate was 100% at 1 year with no neurologic events.
  
  
  CONCLUSIONS
  The third-generation, continuous flow device can provide durable support in the pediatric population. The selection strategy for patients who benefit most from the device continues to evolve. It is anticipated that a smaller design in the future will benefit an even wider pediatric population with heart failure.
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Ed
authors.initials: E
authors.lastname: Peng
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Kirk
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Wrightson
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Phuoc
authors.initials: P
authors.lastname: Duong
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Lee
authors.initials: L
authors.lastname: Ferguson
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Massimo
authors.initials: M
authors.lastname: Griselli
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Butt
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: John J
authors.initials: JJ
authors.lastname: O'Sullivan
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Guy A
authors.initials: GA
authors.lastname: MacGowan
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Crossland
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
authors.forename: Stephan
authors.initials: S
authors.lastname: Schueler
authors.affiliation: Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom. Electronic address: asif.hasan@nuth.nhs.uk.
authors.forename: Asif
authors.initials: A
authors.lastname: Hasan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016278:Ventricular Function, Right / Q000502:physiology