Heart failure and ventricular assist device (VAD)

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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.

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