What is it about?
Children with congenital heart diseases require mechanical support due to severe hypoxia or severe heart failure not responding to medical therapy before or after heart surgery. TandemHeart VAD is a ventricular assist device used in adult for severe heart failure. It has also been used with circuit modification in children with heart diseases. We describe our experiences using TandemHeart VAD with a modified circuit and oxygenator to provide extracorporeal cardiopulmonary support in neonates.
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Why is it important?
TandemHeart Ventricular Assist Device has been used in the past in children with improved morbidity and mortality. There are paucity of data on its' use in neonate. This is the first study that describes successful use of TandemHeart VAD with modified circuit for extracorporeal support in neonates.
Perspectives
Extracorporeal Membrane Oxygenation (ECMO) has been the main mode of extracorporeal support in children with heart failure before and after cardiac surgery. However, there has been considerable morbidity (bleeding/ thrombosis) and mortality associated with ECMO support in children with congenital heart diseases. In addition, ECMO requires involvement of multiple services (ECMO director, primer, specialist, RN) that can delay the initiation of support, complicate management and increase cost. In addition, we don't have an in-house ECMO team, that makes E-CPR impossible. So, our cardiac program as a team moved to a more versatile extracorporeal support system using TandemHeart VAD with modified circuit. Cardiac surgeon and intensivists decide who needs extracorporeal support, doesn't need involvement of our ECMO team, doesn't need more than a bedside nurse to manage the patient with cardiac surgeon, intensivist and perfusionist as needed. It has improved our ECLS implantation time, simplified the management and improved the overall outcome.
Shamsur Chowdhury
Wolfson Children's Hospital- University of Florida College of Medicine, Jacksonville
Read the Original
This page is a summary of: Mechanical circulatory support using modified TandemHeart ventricular assist device in neonates with CHD, Cardiology in the Young, August 2018, Cambridge University Press,
DOI: 10.1017/s1047951118001245.
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