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Ventricular assist devices are a well-established treatment for pediatric end-stage heart failure, though complication rates remain high and outcomes in complex circulations are often adverse.
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This review highlights the increasing and successful use of VADs in pediatric end-stage heart failure, while emphasizing the need for pediatric-specific devices and better management of complications.
PURPOSE OF REVIEW: Ventricular assist devices (VADs) have revolutionized heart failure management in adults. Recently, VADs have similarly taken a prominent role in the management of end-stage heart failure in children. The purpose of this review is to describe the indications for VADs in children, types of devices available, current outcomes, and future directions of VAD therapy. RECENT FINDINGS: There has been a dramatic increase in VAD utilization in children over the last decade. For small children, paracorporeal pneumatic pulsatile pumps (e.g., Berlin Heart EXCOR VAD, Berlin Heart GmbH, Berlin, Germany) are most commonly utilized for long-term support. In older children, intracorporeal continuous flow devices (e.g., HeartMate II Left Ventricular Assist System, Thoratec Corporation, Pleasanton, California, USA and HeartWare Ventricular Assist System, HeartWare Incorporated, Framingham, Massachusetts, USA) have been used and allow the possibility of destination therapy. Other devices, such as the total artificial heart, can be utilized for selected patients. Although overall outcomes of pediatric VADs are favorable, complication rates remain high. The utilization of VADs in complex circulations, such as single ventricle patients, remains infrequent and is associated with a high rate of adverse outcomes. SUMMARY: VADs are well-established treatment for end-stage heart failure in children. Further investigation is needed to refine patient selection criteria, minimize complications, and develop additional pediatric-specific devices.
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O’Connor et al. (2013) conducted a review in end-stage heart failure in children. Ventricular assist devices (VADs) was evaluated. Ventricular assist devices are a well-established treatment for pediatric end-stage heart failure, though complication rates remain high and outcomes in complex circulations are often adverse.
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