Langanecha Bhavikkumar, Honjo Osami, Power Alyssa, Zaulan Oshri, Haller Christoph, George Kristen, Fazari Linda, Maurich Andrea, Chiasson David, Jeewa Aamir
Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada.
Division of Critical Care Medicine, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada.
JHLT Open. 2024 Nov 17;7:100181. doi: 10.1016/j.jhlto.2024.100181. eCollection 2025 Feb.
Ventricular assist device (VAD) explantation following myocardial functional recovery (MFR) for heart failure (HF) is uncommon in children and is associated with a risk of HF recurrence.
Retrospective, single-center study of pediatric patients who were supported with durable VADs, both intracorporeal continuous flow devices (CFD) and paracorporeal pulsatile flow devices (PFD), between 2004 and 2022.
A total of 74 children, of which 43 were female, underwent VAD implantation (PFD = 61 and CFD = 14) at a median (interquartile range) age of 5.6 (0.8, 13.5) years and with a weight of 16.2 (7.5, 40.7) kg. From this cohort, we identified 9 of 75 (12%) children who underwent VAD explantation for MFR. Of those, 7 of 9 (77%) were under 2 years of age and 6 of 9 (67%) were supported for >90 days. Five patients had dilated cardiomyopathy, 3 with anomalous left coronary artery from pulmonary artery and 1 with tachycardia-induced cardiomyopathy. Six were listed for transplantation as a part of their HF management strategy following VAD implantation. After explant, 8 of 9 patients remained in HF remission with no symptoms and stable left ventricular function. One patient had a recurrence of HF following explantation after demonstrating MFR while on VAD support.
MFR resulting in VAD explantation is feasible in children with chronic HF especially for those <2 years of age. Further work is needed to better identify the features that promote MFR and maintain it after explant.
心力衰竭（HF）患儿在心肌功能恢复（MFR）后进行心室辅助装置（VAD）植入术的情况并不常见，且与HF复发风险相关。
对2004年至2022年间接受耐用VAD支持的儿科患者进行回顾性单中心研究，这些VAD包括体内连续流装置（CFD）和体外搏动流装置（PFD）。
共有74名儿童接受了VAD植入术（PFD = 61例，CFD = 14例），其中43名女性，中位（四分位间距）年龄为5.6（0.8，13.5）岁，体重为16.2（7.5，40.7）kg。在这个队列中，我们确定了75名儿童中有9名（12%）因MFR进行了VAD植入术。其中，9名中有7名（77%）年龄在2岁以下，9名中有6名（67%）接受支持超过90天。5例患有扩张型心肌病，3例患有肺动脉起源异常左冠状动脉，1例患有心动过速性心肌病。6例作为VAD植入术后HF管理策略的一部分被列入移植名单。植入术后，9名患者中有8名仍处于HF缓解期，无症状且左心室功能稳定。1例患者在VAD支持下出现MFR后植入术后HF复发。
对于慢性HF患儿，尤其是2岁以下的患儿，因MFR导致的VAD植入术是可行的。需要进一步开展工作，以更好地识别促进MFR并在植入术后维持MFR的特征。
