Clinical Outcomes in Pediatric Patients Implanted With Thoratec® Ventricular Assist Device

Most mechanical circulatory support devices are designed for adult patients; however, some can be successfully applied to pediatric patients. The rates of complications and patient survival to transplant or native heart recovery after implantation of the Thoratec® ventricular assist device (VAD) (Thoratec Corp, Pleasanton, CA) in children and adolescents were determined from the company's voluntary registry. As of January 2005, 209 patients (mean age 14.5 years; range 5 to 18 years) have been supported with the Thoratec® VAD. Mean patient weight was 57 kg (range, 17 to 118 kg), and patients had a mean body surface area of 1.6 m2 (range, 0.73 to 2.3 m2). The major etiologies necessitating VAD support included cardiomyopathy (55.0%), acute myocarditis (25.4%), and end-stage congenital heart disease (5.8%). Mean duration of VAD support was 44 days (range, 0 to 434 days). Patient survival to transplantation or native heart recovery was 68.4%. Patients with cardiomyopathy and acute myocarditis had 74.1% and 86.0% survival, respectively, with only 27.3% survival in patients having congenital heart disease. The overall survival rate in smaller children (body surface area, <1.3 m2) was similar at 51.7%, although the incidence of congenital heart disease was higher.