Pediatric ventricular assist devices: current challenges and future prospects

Autor: Iki Adachi, Sarah Burki
Rok vydání: 2017
Předmět:
Time Factors
Endocrinology
Diabetes and Metabolism
medicine.medical_treatment
Review
030204 cardiovascular system & hematology
law.invention
miniaturization
0302 clinical medicine
Randomized controlled trial
Risk Factors
law
Ventricular Function
Pharmacology (medical)
anticoagulation
Age Factors
SV
Hematology
General Medicine
chronic graft dysfunction
Treatment Outcome
Preclinical testing
Child
Preschool
Cardiology and Cardiovascular Medicine
Thrombotic complication
Heart Defects
Congenital
medicine.medical_specialty
Waiting Lists
Investigational device exemption
Prosthesis Design
Food and drug administration
03 medical and health sciences
single ventricle
children
medicine
Humans
Intensive care medicine
Heart Failure
mechanical circulatory support
business.industry
Body Weight
Infant
Newborn
Public Health
Environmental and Occupational Health
Anticoagulants
Infant
Recovery of Function
MCS
030228 respiratory system
Ventricular assist device
Heart Transplantation
Heart-Assist Devices
business
Outpatient management
Destination therapy
Zdroj: Vascular Health and Risk Management
ISSN: 1178-2048
DOI: 10.2147/vhrm.s82379
Popis: The field of mechanical circulatory support has made great strides in the preceding 2 decades. Although pediatric mechanical circulatory support has lagged behind that of adults, the gap between them is expected to close soon. The only device currently approved by the US Food and Drug Administration for use in children is the Berlin Heart EXCOR ventricular assist device (VAD). The prospective Berlin Heart Investigational Device Exemption Trial demonstrated good outcomes, such as bridge to transplantation or recovery, in ~90% of children supported with this device. However, a high incidence of hemorrhagic and thrombotic complications was also noted. As a result, pediatric centers have just started implanting adult intracorporeal continuous-flow devices in children. This paradigm shift has opened a new era in pediatric mechanical circulatory support. Whereas children on VAD were previously managed exclusively in hospital, therapeutic options such as outpatient management and even destination therapy have been becoming a reality. With continued miniaturization and technological refinements, devices currently in development will broaden the range of options available to children. The HeartMate 3 and HeartWare MVAD are two such compact VADs, which are anticipated to have great potential for pediatric use. Additionally, a pediatric-specific continuous-flow VAD, the newly redesigned Jarvik Infant 2015, is currently undergoing preclinical testing and is expected to undergo a randomized clinical trial in the near future. This review aims to discuss the challenges posed by the use of intracorporeal adult continuous-flow devices in children, as well as to provide our perspective on the future prospects of the field of pediatric VADs.
Databáze: OpenAIRE
Externí odkaz: