Skip to content

Heart failure and ventricular assist device (VAD)

SHARE VIA:

Share on facebook
Share on twitter
Share on linkedin
Share on whatsapp

Modified Ross heart failure classification:

Class Symptoms
I Asymptomatic
II Mild tachypneoa or diaphoresis with feeding. Dyspnea on exertion in older children
III Marked tachypnea or diaphoresis with feeding; marked dyspnea on exertion; prolonged feeding time with failure to thrive
IV Tachypnea, retractions, grunting or diaphoresis at rest

 


Causes:

  • Congenital, skeletal myopathy with cardiac involvment (e.g. Duchenne, Becker, Barth Syndrome, myotonic dystrophy)
  • Metabolic disorders with cardiac involvement (carnitine deficiency, glycogen storage disease, mitochondrial disease)
  • Cardiomyopathy (primary, secondary)
  • Acquired (rheumatic heart disease, myocarditis, tachyarrythmia, toxic, antineoplastic drugs, nutritional deficiency)

Treatment:

Treatment of the underlying cause and cardiomyopathy.


Mechanical treatment options (ECLS):

Short term support: IABP (diastolic augmentation), Impella axial flow (minimum weight 25 kg), centrifugal pumps (Levitronix), ECMO

Mid-term support /bridge to transplantation/bridge to recovery: Thoratec, Berlin heart


References:

[1] European Journal of Pediatrics, 2010, 169, 403 – 410: Kantor et all: Clinical Practice: Heart Failure in Children. Part II. Current maintenance therapy and new therapeutic approaches

[2] Circulation 110:975-981: Stevenson LW: Left ventricular assist device as destination for patients undergoing intravenous inotropic therapy: a subset analysis from REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure).

[3] Ann Thorac Surg 1999; 67: 1415-20. Akomea-Agyin: Intraaortic balloon pumpi in children.

[4] J. Thorac. Cardiovasc. Surg., July 1, 2011; 142(1): 60 – 65. Lamarche et al: Comparative outcomes in cardiogenic shock patients managed with Impella microaxial pump or extracorporeal life support

[5] John et al. J Thorac Cardiovasc Surg.2011; 141: 932-939. Outcomes of a multicenter trial of the Levitronix CentriMag ventricular assist system.

[6] Reinhartz O, Keith FM, El-Banayosy A, et al. Multicenter experience with the thoratec ventricular assist device in children and adolescents. J Heart Lung Transplant 2001; 20: 439-48.

[7] Current Cardiology Reviews, 2010, 6, 46-53. Gazit et al: Mechanical Circulatory Support of the Critically Ill Child Awaiting Heart Transplantation.

[8] J Heart Lung Transplant. 2011 Feb;30(2):115-23: Stevenson et al: Third INTERMACS Annual Report: the evolution of destination therapy in the United States.

[9] Interact Cardiovasc Thorac Surg. 2012 Sep;15(3):426-31. The profile of the systemic inflammatory response in children undergoing ventricular assist device support.


All Marc’s PICU cardiology FOAM can be found on PICU Doctor and can be downloaded as a handy app for free on iPhone or AndroidA list of contributors can be seen here.

About the authors

KEEP READING

High flow therapy – when and how?

Chest compressions in traumatic cardiac arrest

Searching for sepsis

The missing link? Children and transmission of SARS-CoV-2

Don’t Forget the Brain Busters – Round 2

An evidence summary of Paediatric COVID-19 literature

Urticaria

The fidget spinner craze – the good, the bad and the ugly

Parenteral Nutrition

Leave a Reply

Your email address will not be published.

DFTB WORLD

EXPLORE BY TOPIC

We use cookies to give you the best online experience and enable us to deliver the DFTB content you want to see. For more information, read our full privacy policy here.
[cmplz-manage-consent]