CARDIAC ASSIST DEVICES

Cardiac assist devices are used in children with severe heart failure when other therapies are no longer effective. These devices are typically used as a bridge-to-heart transplant where they can sustain a failing heart for several months until a suitable donor heart becomes available. In some cases, a device is used as a bridge-to-recovery to help a damaged heart and other affected organs recover and function normally. This might be the case with severe myocarditis or a transplant rejection.

Cardiac assist devices are circulatory heart and lung support machines that mimic the heart’s function by using a mechanical pump to improve the delivery of blood through the body and decrease symptoms of heart failure. The selection of a mechanical device depends on the child’s body size, cause of heart failure, anticipated duration of support, and type of assistance needed.

Ventricular Assist Devices

Ventricular Assist Devices (VADs) can be used either for short-term or long-term support to improve circulation, reverse end-stage dysfunction, and allow for physical rehabilitation to improve a child’s chance for a successful heart transplant. In selecting the appropriate VAD device, decisions need to be made on the type of heart support, pump type, and pump location.

Two types of heart support are available: a left ventricular assist device (LVADs) that takes over the function of the lower left heart chambers or a biventricular assist device (BIVADs) that supports both lower heart chambers. The selected VAD pump (nonpulsatile or pulsatile) depends on the method of blood flow required. The location of the pumping device can either be implanted in the chest (intracorporeal) or placed outside the body (extracorporeal or paracorporeal).

Older children who receive VADs may be discharged from the hospital to wait for a heart transplant at home. They can resume most of their daily activities with certain precautions. For additional information about VADs, the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) website is a helpful resource.

Extracorporeal Membrane Oxygenation

Extracorporeal member oxygenation (ECMO) is an emergency rescue system that provides both circulatory and respiratory support. It mechanically pumps oxygen into the blood and circulates blood through the body.

ECMO is recommended for critically ill children waiting for a donor heart and cannot be considered for a ventricular assist device, especially those who are younger or with heart and lung failure. ECMO can only be used short term because serious complications can develop with extended use, such as bleeding, infection, and blood clots leading to stroke. ECMO Patients who get stronger can be transitioned from to a VAD.