DOI: 10.1161/circ.148.suppl_1.17254 ISSN: 0009-7322

Abstract 17254: Myocardial Functional Recovery Following Durable Ventricular Assist Device in Children

Bhavikkumar Langanecha, Osami Honjo, Alyssa Power, Mjaye Mazwi, Oshri Zaulan, Aine Lynch, Christoph Haller, Kristen George, Linda Fazari, Andrea Maurich, David Chiasson, Aamir Jeewa
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Ventricular Assist Device (VAD) explantation following myocardial functional recovery (MFR) for heart failure (HF) is uncommon and associated with a risk of recurrence of HF.

Research Question: What are the patient characteristics and outcomes for VAD explantation in children following MFR?

Methods: Retrospective, single centre study of patients who were supported with durable VADs, both intracorporeal continuous flow devices (CFD) and paracorporeal pulsatile flow devices (PFD) between 2004 to 2022.

Results: A total of 75 children, of which 43 were female, underwent VAD implantation (PFD = 61 and CFD = 14) at a median (IQR) 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 8/75 (11%) children who underwent VAD explantation for MFR after a median duration of 56 (22, 115) days. All were supported with durable PFD. Five were listed for transplantation as a part of their HF management strategy following VAD implantation and four patients had dilated cardiomyopathy (DCM). Of those, 7/8 (88%) children with MFR were under 2 years of age and 5/8 (63%) were supported for > 90 days. The pathological findings on the LV core samples were variable in severity and no patient had any evidence of active inflammation (see Table). After explant, 7/8 patients remained in HF remission with no symptoms and stable LV function. One patient had a recurrence of HF following explantation after demonstrating MFR while on VAD support. This patient was 5 years old at implant and was in HF remission for ~9 months following explant before HF recurrence, requiring VAD re-implantation and eventual heart transplantation.

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 help better identify the features that promote MFR and maintain it after explant.

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