Deng Mimi Xiaoming, Yoshida Nao, Haller Christoph, Jeewa Aamir, Yoo Shi-Joon, Honjo Osami
Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada.
Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
J Artif Organs. 2025 Jun;28(2):171-176. doi: 10.1007/s10047-024-01467-7. Epub 2024 Sep 6.
Despite the range of body sizes in children, few ventricular assist devices (VAD) exist to support pediatric patients with end-stage heart failure. Large registry data identified weight < 20 kg to be associated with higher rates of VAD-related stroke, compared to > 40 kg. Moreover, patients < 1 years of age experience the highest post-implant mortality, with 1-year survival improving in an age-dependent manner. Within different VAD types, intracorporeal continuous (IC) devices confer the greatest clinical benefit and quality of life compared to paracorporeal alternatives. The major limitation of IC VADs is the technical challenge of implantation into patients of small body size, thus the majority of patients with IC devices are pre-adolescents or older. However, since 2021, the use of HeartMate 3™ (HM3) has expanded to patients as small as 17.7 kg. Although HM3 offers equally favorable survival outcomes irrespective of body size, patients of low body surface area are more likely to experience non-device-related major infections and renal dysfunction, with suggestion for elevated risk of major bleeding and stroke. Innovative imaging strategies have emerged to assess the feasibility of HM3 implantation and facilitate preoperative planning in small children. Moreover, the unmet need for an IC device in the infant population has revived interest in the axial pump, with a pivotal clinical trial currently underway. VAD outcomes in the pediatric population are not equivalent across all ages and body sizes, thus size-stratified analyses and device development to serve the full spectrum of body habitus are key considerations as this field rapidly evolves.
尽管儿童体型各异，但用于支持终末期心力衰竭儿科患者的心室辅助装置（VAD）却很少。大型登记数据显示，与体重超过40千克的患者相比，体重小于20千克的患者发生VAD相关中风的几率更高。此外，1岁以下的患者植入后死亡率最高，1年生存率随年龄增长而提高。在不同类型的VAD中，与体外替代装置相比，体内连续（IC）装置带来的临床益处和生活质量最大。IC VAD的主要局限性在于植入小体型患者时面临技术挑战，因此大多数使用IC装置的患者是青春期前或年龄更大的儿童。然而，自2021年以来，HeartMate 3™（HM3）的使用范围已扩大到体重低至17.7千克的患者。尽管无论体型大小，HM3都能提供同样良好的生存结果，但低体表面积的患者更有可能发生与装置无关的严重感染和肾功能障碍，且有大出血和中风风险升高的迹象。已出现创新的成像策略来评估HM3植入的可行性，并便于为幼儿进行术前规划。此外，婴儿群体对IC装置的需求尚未满足，这重新引发了人们对轴流泵的兴趣，目前一项关键的临床试验正在进行中。儿科患者的VAD治疗结果在所有年龄和体型中并不相同，因此，随着该领域的迅速发展，进行体型分层分析以及开发适用于各种体型的装置是关键考虑因素。
