Emergency implantation of a left ventricular assist device in adolescents with biventricular failure

Adolescents with congestive cardiomyopathy who present with intractable arr hythmia or progressive Ventricular failure have a very poor prognosis and o ften die awaiting cardiac transplantation (CTx). We present our recent expe rience with a pneumatically powered left ventricular assist device (LVAD) i mplanted emergently to salvage adolescents with severe biventricular failur e. Four patients, aged 15-17 years, body surface areas of 1.5-1.7 m(2), wit h dilated cardiomyopathy (LV diastolic dimension, 7.1-8.3 cm); two presente d with cardiovascular collapse, one with refractory ventricular tachycardia , and one with cardiac arrest. Hemodynamic and biochemical data before and 1 week after LVAD placement are expressed as mean and range values. None of the patients required right ventricular assist, and all patients achieved functional recovery while on LVAD support (8-71 days). Currently, all four patients are alive (11-22 months) after successful CTx. We conclude that em ergency implantation of an LVAD in adolescents with biventricular heart fai lure can be life saving. As has been shown in the adult population, such a ventricular assist system restores normal circulatory hemodynamics, reverse s multi-organ dysfunction, and provides a "safe" bridge to transplantation.