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Pediatric heart failure: current state and future possibilities.

Rossano JW, Jang GY - Korean Circ J (2015)

Bottom Line: The condition is associated with a high rate of morbidity and mortality and places a significant burden on families of affected children and to society as a whole.Current medical therapy is taken largely from the management of heart failure in adults, though clear survival benefit of these medications are lacking.There is an ongoing investigation to improve outcomes in high-risk populations, such as small infants and those with complex congenital heart disease, including patients with functionally univentricular hearts.

View Article: PubMed Central - PubMed

Affiliation: The Cardiac Center, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

ABSTRACT
Heart failure is a complex pathophysiological syndrome that can occur in children from a variety of diseases, including cardiomyopathies, myocarditis, and congenital heart disease. The condition is associated with a high rate of morbidity and mortality and places a significant burden on families of affected children and to society as a whole. Current medical therapy is taken largely from the management of heart failure in adults, though clear survival benefit of these medications are lacking. Ventricular assist devices (VADs) have taken an increasingly important role in the management of advanced heart failure in children. The predominant role of these devices has been as a bridge to heart transplantation, and excellent results are currently achieved for most children with cardiomyopathies. There is an ongoing investigation to improve outcomes in high-risk populations, such as small infants and those with complex congenital heart disease, including patients with functionally univentricular hearts. Additionally, there is an active investigation and interest in expansion of VADs beyond the predominant utilization as a bridge to a heart transplant into ventricular recovery, device explant without a heart transplantation (bridge to recovery), and placement of devices without the expectation of recovery or transplantation (destination therapy).

No MeSH data available.


Related in: MedlinePlus

Outcomes of the Prospective Trial of the Berlin Excor (Berlin Heart Inc.) ventricular assist device to a historical cohort of extracorporeal membrane oxygenation (ECMO) patients. A: cohort 1 included patients with a body surface area <0.7 m2. B: cohort 2 included patients with body surface area 0.7 to <1.5 m2. Adopted from Fraser CD Jr, et al. with permission from the publisher.62)
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Figure 4: Outcomes of the Prospective Trial of the Berlin Excor (Berlin Heart Inc.) ventricular assist device to a historical cohort of extracorporeal membrane oxygenation (ECMO) patients. A: cohort 1 included patients with a body surface area <0.7 m2. B: cohort 2 included patients with body surface area 0.7 to <1.5 m2. Adopted from Fraser CD Jr, et al. with permission from the publisher.62)

Mentions: It is arguable that the greatest advance in pediatric heart failure over the last decade has been the increased utilization and success of VADs for patients with end-stage heart failure.56)57) Until relatively recently, the only modality available for small children with profound and refractory hear failure was extracorporeal membrane oxygenation (ECMO). This modality is not ideal for long-term support for heart failure and is one of the strongest risk factors for death while waiting for heart transplantation and for death after transplantation.58)59) The Berlin Heart Excor (Berlin Heart Inc., Woodlands, TX, USA) VAD was first used in the early 1990's in Germany (Fig. 3).60) It was subsequently spread beyond Europe to North America. By the early 2000's, centers in the United States and Canada had gained ample experience with the device and reported good results with a high success rate as a bridge to heart transplantation.56)61) These results led to a prospective multi-center evaluation of the device that compared the VAD to a retrospective cohort of patients treated with ECMO.62) The Excor VAD performed well in the trial with 88-92% patients surviving to heart transplantation or weaning from the device with a favorable neurological outcome (Fig. 4). This result was a significant improvement over ECMO, where there were no patients alive on ECMO after thirty days of support.


Pediatric heart failure: current state and future possibilities.

Rossano JW, Jang GY - Korean Circ J (2015)

Outcomes of the Prospective Trial of the Berlin Excor (Berlin Heart Inc.) ventricular assist device to a historical cohort of extracorporeal membrane oxygenation (ECMO) patients. A: cohort 1 included patients with a body surface area <0.7 m2. B: cohort 2 included patients with body surface area 0.7 to <1.5 m2. Adopted from Fraser CD Jr, et al. with permission from the publisher.62)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310974&req=5

Figure 4: Outcomes of the Prospective Trial of the Berlin Excor (Berlin Heart Inc.) ventricular assist device to a historical cohort of extracorporeal membrane oxygenation (ECMO) patients. A: cohort 1 included patients with a body surface area <0.7 m2. B: cohort 2 included patients with body surface area 0.7 to <1.5 m2. Adopted from Fraser CD Jr, et al. with permission from the publisher.62)
Mentions: It is arguable that the greatest advance in pediatric heart failure over the last decade has been the increased utilization and success of VADs for patients with end-stage heart failure.56)57) Until relatively recently, the only modality available for small children with profound and refractory hear failure was extracorporeal membrane oxygenation (ECMO). This modality is not ideal for long-term support for heart failure and is one of the strongest risk factors for death while waiting for heart transplantation and for death after transplantation.58)59) The Berlin Heart Excor (Berlin Heart Inc., Woodlands, TX, USA) VAD was first used in the early 1990's in Germany (Fig. 3).60) It was subsequently spread beyond Europe to North America. By the early 2000's, centers in the United States and Canada had gained ample experience with the device and reported good results with a high success rate as a bridge to heart transplantation.56)61) These results led to a prospective multi-center evaluation of the device that compared the VAD to a retrospective cohort of patients treated with ECMO.62) The Excor VAD performed well in the trial with 88-92% patients surviving to heart transplantation or weaning from the device with a favorable neurological outcome (Fig. 4). This result was a significant improvement over ECMO, where there were no patients alive on ECMO after thirty days of support.

Bottom Line: The condition is associated with a high rate of morbidity and mortality and places a significant burden on families of affected children and to society as a whole.Current medical therapy is taken largely from the management of heart failure in adults, though clear survival benefit of these medications are lacking.There is an ongoing investigation to improve outcomes in high-risk populations, such as small infants and those with complex congenital heart disease, including patients with functionally univentricular hearts.

View Article: PubMed Central - PubMed

Affiliation: The Cardiac Center, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

ABSTRACT
Heart failure is a complex pathophysiological syndrome that can occur in children from a variety of diseases, including cardiomyopathies, myocarditis, and congenital heart disease. The condition is associated with a high rate of morbidity and mortality and places a significant burden on families of affected children and to society as a whole. Current medical therapy is taken largely from the management of heart failure in adults, though clear survival benefit of these medications are lacking. Ventricular assist devices (VADs) have taken an increasingly important role in the management of advanced heart failure in children. The predominant role of these devices has been as a bridge to heart transplantation, and excellent results are currently achieved for most children with cardiomyopathies. There is an ongoing investigation to improve outcomes in high-risk populations, such as small infants and those with complex congenital heart disease, including patients with functionally univentricular hearts. Additionally, there is an active investigation and interest in expansion of VADs beyond the predominant utilization as a bridge to a heart transplant into ventricular recovery, device explant without a heart transplantation (bridge to recovery), and placement of devices without the expectation of recovery or transplantation (destination therapy).

No MeSH data available.


Related in: MedlinePlus