Implantable left ventricular assist devices can successfully bridge adolescent patients to transplant

Background: Left ventricular assist devices (LVAD) have been used successfu lly as a life-sustaining bridge to transplantation in adults with end-stage heart failure. Longterm implantable cardiac assist devices for smaller ado lescent patients are not yet available in the United States. Methods: This study reviews the experience with patients less than 21 years old that received HeartMate LVADs (TCI) at our institution. Twelve patient s were implanted with 13 LVADs. The patients ranged in age from 11 to 20 ye ars (mean 16 years). Body surface area ranged from 1.4 to 2.2 m(2) (mean 1. 8 m(2)). Patients were selected for LVAD placement based on eligibility for heart transplant and evidence of end-organ dysfunction, Device placement i n small patients was facilitated with prosthetic graft abdominal wall closu re. No patient received systemic anticoagulation, Results: The duration of LVAD support ranged from 0 to 397 days (mean 123 d ays). Seven of the 8 patients eligible for discharge from the hospital with a vented-electric LVAD were supported at home while awaiting transplantati on. Outcomes of LVAD support were: LVAD explantation in 2 cases (15%), expi ration with LVAD in place in 3 cases (23%), and successful transplantation in 8 cases (62%). Complications included 4 patients with systemic infection , 3 re-operations for hemorrhage, 1 embolic event, and 1 intraoperative air embolus that proved fatal. One explanted patient required a subsequent LVA D and the other expired 4 months after explantation. Six of the 8 transplan ted patients are alive and well with follow-up ranging from 8 to 43 months. Conclusions: Adolescent patients with heart failure can be successfully sup ported on a long-term basis to heart transplantation with the HeartMate LVA D, The wearable device allows for discharge home while awaiting transplanta tion. Device explantation without subsequent transplantation can be unpredi ctable. The incidence of thromboembolism remains low despite the absence of systemic anticoagulation. The technique of prosthetic graft closure of the abdominal wall facilitates the use of this device in smaller patients. .