Successful Management of Short-Term Continuous-Flow Ventricular Assist Device for a Pediatric Patient: Report of a Case

Abstract

The importance of the short-term continuous-flow ventricular assist device (STCF-VAD) for the management of pediatric patients with refractory cardiogenic shock is growing along with the increasing use of the Berlin Heart EXCOR pediatric ventricular assist device. Nevertheless, clinical experience with the STCF-VAD for pediatric patient is insufficient with unsatisfactory outcomes to date, especially in Japan. We report our experience of one month of successful management of the STCF-VAD in a one-year-old boy of dilated cardiomyopathy. He was previously treated with VA-ECMO, and then converted to the STCF-VAD as a bridge to the EXCOR. Although six times of circuit exchanges were required due to thrombus formation, the patients experienced no complication and finally converted to the EXCOR after 29 days of STCF-VAD support. Our experience suggests that adequate antithrombotic therapy to reduce the risk of both thrombogenesis and hemorrhagic complications, frequent assessment of the circuit to detect thrombi as early as possible, and prompt circuit exchange in case of a floating or growing thrombus are the key to preventing adverse events. Application of percutaneous cannulae exclusively for the EXCOR might also be advantageous for prevention of thrombogenesis and elimination of re-open chest surgery at the transition to the EXCOR. The STCF-VAD therapy requires highly strict management, and therefore should be managed by an experienced medical team.