PEDIATRICS

M. Ono¹, T. Nishimura², A. Saito³, K. Nawata³, O. Kinoshita³, M. Hisagi³, N. Motomura³, S. Kyo^2
1Department Of Cardiothoracic Surgery, University of Tokyo, Tokyo/JAPAN, ²Department Of Therapeutic Strategy For Heart Failure, The University of Tokyo, Tokyo/JAPAN, ³, University of Tokyo, Tokyo/JAPAN

Body: Introduction: Several kinds of implantable ventricular assist device (VAD) have been developed to facilitate the implantation in patients with a wide range of body sizes. Pediatric or female patients with small body size still do not, however, enjoy the benefits of these new technologies. Papracorporeal VAD was used to support the hemodynamic condition in small-body-size patients with end-stage heart failure.. We report the greatly improved results of paracorporeal VAD implantation in small size patients. Methods: Toyobo-NCVC paracorporeal VAD was implanted in 16 small size patients (body surface area less than 1.4 m²) with an intention of bridge to transplantation. There were ten female patients. Age ranged from 10 to 58 years with an average of 32.9 years. Four patients were 16 years old or younger. Body surface area ranged from 1.05 to 1.39 m² with an average of 1.27 m². Nine patients had dilated cardiomyopathy, three had other type of cardiomyopathy and two had congenital heart disease. Ten patients were in INTERMACS profile 1 before implantation, and six in profile 2. Three patients required biventricular support. Mitral and/or tricuspid annuloplasty was performed in ten patients, and left ventricular thrombectomy in one. All survived patients joined a rehabilitation program. Patients were followed-up for 29 months (16 days to 89 months) after VAD implantation. Results: All patients tolerated the VAD implantation. Two patients died late after implantation due to sepsis, one from liver failure. Four patients underwent heart transplantation after 280-day long support. All are well and alive for 28 months after heart transplantation. Three patients could be weaned from VAD after 327-day long support due to aggressive weaning protocol. Seven patients are awaiting heart transplantation on VAD support. VAD support period ranged from 16 to 807 days with an average of 368 days. One, three, and five-year survival rates were 81.3%, 81.3% and 81.3%, respectively.Conclusion: Improved long-term survival was obtained by paracorporeal VADimplantation in small-body-size patients with an intention of bridge to transplantation. Paracorporeal VAD implantation can be a vital option for treatment of end-stage heart failure insmall-body-size patients. Further study is mandatory to prove safety and efficacy of paracorporeal ventricular assist device treatment in this patient population.

Disclosure: All authors have declared no conflicts of interest.