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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

The Infant-Size Pediatric Jarvik 200, part of the national heart, lung, and blood institute pediatric circulatory support program. Adopted from Baldwin JT, et al. with permission from the publisher.67)
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Figure 5: The Infant-Size Pediatric Jarvik 200, part of the national heart, lung, and blood institute pediatric circulatory support program. Adopted from Baldwin JT, et al. with permission from the publisher.67)

Mentions: While many pediatric patients can be well supported with the currently available VADs, there remains certain populations that are still challenging. Small infants with cardiomyopathies still have high adverse events and mortality rate. The National Institutes of Health/National Heart, Lung, and Blood Institute sponsored Pumps for Kids, Infants, and Neonates (PumpKIN) program plans to initiate a trial of the Infant Jarvik VAD in 2015 (Fig. 5).67) Likewise, patients with complex congenital heart disease, including circulatory failure after the Fontan operation, often fare poorly on VADs. As circulatory failure is complex in this population, including the relatively high subset of patients with circulatory failure with relatively preserved ventricular function, a systemic VAD is often inadequate. Limited reports of 'biventricular' support with two VADs or with a total artificial heart suggest patients can be successfully supported to heart transplantation, though further study is needed on the optimal method of support for this population.68)69)


Pediatric heart failure: current state and future possibilities.

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

The Infant-Size Pediatric Jarvik 200, part of the national heart, lung, and blood institute pediatric circulatory support program. Adopted from Baldwin JT, et al. with permission from the publisher.67)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: The Infant-Size Pediatric Jarvik 200, part of the national heart, lung, and blood institute pediatric circulatory support program. Adopted from Baldwin JT, et al. with permission from the publisher.67)
Mentions: While many pediatric patients can be well supported with the currently available VADs, there remains certain populations that are still challenging. Small infants with cardiomyopathies still have high adverse events and mortality rate. The National Institutes of Health/National Heart, Lung, and Blood Institute sponsored Pumps for Kids, Infants, and Neonates (PumpKIN) program plans to initiate a trial of the Infant Jarvik VAD in 2015 (Fig. 5).67) Likewise, patients with complex congenital heart disease, including circulatory failure after the Fontan operation, often fare poorly on VADs. As circulatory failure is complex in this population, including the relatively high subset of patients with circulatory failure with relatively preserved ventricular function, a systemic VAD is often inadequate. Limited reports of 'biventricular' support with two VADs or with a total artificial heart suggest patients can be successfully supported to heart transplantation, though further study is needed on the optimal method of support for this population.68)69)

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