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DOI: 10.1055/s-0032-1332362
Minimally-invasive LVAD-implantation as bridging to transplant strategy in treatment of cardiac failure in middle-aged children
Objective: The role and the use of left ventricular assist devices (LVAD) for the treatment of cardiac failure is worldwide tremendously increasing and new studies show the benefit of bridging to transplant by VAD versus ECMO therapy. However, the number of LVADs implanted in children is rare due to the lack of clinical experience. Therefore, we aimed to demonstrate the treatment and outcome of middle-aged children in whom LVAD-implantation (HVAD, HeartWare) was performed with a novel minimally-invasive surgical technique.
Methods: We analysed the data of young patients with end-stage cardiac failure based on dilative cardiomyopathy who were operated with a novel minimally-invasive LVAD-implantation-technique: upper hemisternotomy combined with antero-lateral thoracotomy.
Results: In two young patients (one male/one female, seven and nine years old) a novel, minimized approach for LVAD-implantation was used. Both patients suffered from DCM. Mean weight of the patient population at time of implantation was 25 kg and the mean ICU-length-of-stay was 31 days. Further stay on normal ward was totally uneventful. Even after 6 and 3 months of successful LVAD-therapy there was no sign of recovery seen. None of the patients revealed wound infections of the thoracotomy and no thrombembolic complications were seen. Finally, all patients were discharged in stable condition and successfully listed for cardiac transplantation.
Conclusion: The treatment of cardiac failure in middle-aged children through minimally-invasive LVAD-implantation as a bridge to transplant shows considerable positive effects. Minimal surgical trauma lowers the risk of wound infections and the positive outcome of our patients demonstrate advantages in the treatment of cardiac failure by LVAD implantation even in this younger age group until heart transplantation will be performed.