Ventricular Assist Devices in Pediatrics
Ventricular Assist Devices (VAD)
Overview
Ventricular Assist Devices are mechanical circulatory support systems designed to augment or replace ventricular function in pediatric patients with severe heart failure, either as a bridge to transplantation, recovery, or as destination therapy.
Key Components
- Basic Components:
- Blood pump (internal)
- Inflow and outflow cannulas
- Power source (external)
- Controller system
- Driveline
- Support Options:
- Left Ventricular Support (LVAD)
- Right Ventricular Support (RVAD)
- Biventricular Support (BiVAD)
- Total Artificial Heart (TAH)
Indications
- Primary Indications:
- End-stage heart failure
- Cardiogenic shock
- Bridge to transplantation
- Bridge to recovery
- Post-cardiotomy failure
- Specific Conditions:
- Dilated cardiomyopathy
- Myocarditis
- Congenital heart disease
- Post-transplant graft failure
Types and Selection
Device Categories
- Continuous Flow Devices
- Axial flow pumps
- Centrifugal flow pumps
- Advantages:
- Smaller size
- Better durability
- Lower thrombosis risk
- Pulsatile Flow Devices
- Pneumatic devices
- Electric devices
- Advantages:
- More physiologic flow
- Better RV support
- Potential for recovery
Selection Criteria
- Patient Factors:
- Body size and age
- Anatomical considerations
- Ventricular function
- Anticipated support duration
- Device Factors:
- Size compatibility
- Flow requirements
- Support type needed
- Available institutional expertise
Patient Management
Perioperative Care
- Preoperative Preparation
- Detailed imaging studies
- Optimization of organ function
- Infection screening
- Family education
- Immediate Postoperative Care
- Hemodynamic monitoring
- Ventilator management
- Bleeding control
- Right heart support
Long-term Management
- Device Monitoring
- Flow parameters
- Power consumption
- Alarms review
- Driveline care
- Medical Management
- Anticoagulation protocol
- Blood pressure control
- Heart failure therapy
- Infection prevention
- Rehabilitation
- Early mobilization
- Physical therapy
- Nutritional support
- Psychological support
Complications and Troubleshooting
Major Complications
- Bleeding
- Surgical site bleeding
- Gastrointestinal bleeding
- Intracranial hemorrhage
- Management strategies
- Thrombosis
- Pump thrombosis
- Systemic thromboembolism
- Prevention protocols
- Treatment approaches
- Infection
- Driveline infections
- Pocket infections
- Bloodstream infections
- Prevention strategies
Device-Related Issues
- Technical Problems
- Controller malfunction
- Power failure
- Cable damage
- Pump failure
- Emergency Response
- Backup controller use
- Battery management
- Emergency contact protocols
- CPR modifications
Quality of Life Considerations
- Daily Living
- Activity restrictions
- School attendance
- Social integration
- Family support
- Long-term Outcomes
- Survival rates
- Functional status
- Psychological adjustment
- Transition planning
