Myocardial functional recovery following durable ventricular assist device in children
Background: 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. Material and Methods: Retrospective, single-center study of pediatric patients who were supported wit...
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Elsevier
2025-02-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133424001307 |
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| author | Bhavikkumar Langanecha Osami Honjo Alyssa Power Oshri Zaulan Christoph Haller Kristen George Linda Fazari Andrea Maurich David Chiasson Aamir Jeewa |
| author_facet | Bhavikkumar Langanecha Osami Honjo Alyssa Power Oshri Zaulan Christoph Haller Kristen George Linda Fazari Andrea Maurich David Chiasson Aamir Jeewa |
| author_sort | Bhavikkumar Langanecha |
| collection | DOAJ |
| description | Background: 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. Material and Methods: 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. Results: 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. Conclusions: 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. |
| format | Article |
| id | doaj-art-717f396ab4654a62a0cb5bd42d49f163 |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-717f396ab4654a62a0cb5bd42d49f1632025-02-09T05:01:56ZengElsevierJHLT Open2950-13342025-02-017100181Myocardial functional recovery following durable ventricular assist device in childrenBhavikkumar Langanecha0Osami Honjo1Alyssa Power2Oshri Zaulan3Christoph Haller4Kristen George5Linda Fazari6Andrea Maurich7David Chiasson8Aamir Jeewa9Labatt 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, CanadaLabatt Family Heart Centre, Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, CanadaLabatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, CanadaLabatt 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, CanadaLabatt Family Heart Centre, Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, CanadaLabatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, CanadaLabatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, CanadaLabatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, CanadaDepartment of Laboratory Medicine & Pathobiology, University of Toronto, Hospital for Sick Children, Toronto, Ontario, CanadaLabatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada; Corresponding author: Aamir Jeewa, Labatt Family Heart Centre, Division of Pediatric Cardiology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1x8, Canada.Background: 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. Material and Methods: 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. Results: 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. Conclusions: 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.http://www.sciencedirect.com/science/article/pii/S2950133424001307left ventricular assist device (LVAD)myocardial functional recoveryventricular assist device explantheart failureheart transplantreverse remodeling |
| spellingShingle | Bhavikkumar Langanecha Osami Honjo Alyssa Power Oshri Zaulan Christoph Haller Kristen George Linda Fazari Andrea Maurich David Chiasson Aamir Jeewa Myocardial functional recovery following durable ventricular assist device in children JHLT Open left ventricular assist device (LVAD) myocardial functional recovery ventricular assist device explant heart failure heart transplant reverse remodeling |
| title | Myocardial functional recovery following durable ventricular assist device in children |
| title_full | Myocardial functional recovery following durable ventricular assist device in children |
| title_fullStr | Myocardial functional recovery following durable ventricular assist device in children |
| title_full_unstemmed | Myocardial functional recovery following durable ventricular assist device in children |
| title_short | Myocardial functional recovery following durable ventricular assist device in children |
| title_sort | myocardial functional recovery following durable ventricular assist device in children |
| topic | left ventricular assist device (LVAD) myocardial functional recovery ventricular assist device explant heart failure heart transplant reverse remodeling |
| url | http://www.sciencedirect.com/science/article/pii/S2950133424001307 |
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