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(Circulation. 2006;113:2266-2268.)
© 2006 American Heart Association, Inc.

Editorial

Pediatric Mechanical Circulatory Support

Challenges and Opportunities

David Rosenthal, MD; Daniel Bernstein, MD

From Packard Children’s Hospital and Department of Pediatrics, Stanford University, Stanford, Calif.

Correspondence to Daniel Bernstein, MD, Stanford University, 750 Welch Rd, Suite #305, Stanford, CA 94304. E-mail danb@stanford.edu

Key Words: Editorials • cardiomyopathy • heart-assist device • pediatrics

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Cardiomyopathy is rare in the pediatric age group, with an annual incidence of only 6 to 12 cases per million children.^1–3 In addition to the genetic and acquired cardiomyopathies, heart failure in children also occurs as a complication of congenital cardiac anomalies, ranging from hypoplastic left heart syndrome to tetralogy of Fallot. In the registry of the International Society of Heart and Lung Transplantation (ISHLT), approximately 65% of heart transplantations in infants were performed as the result of congenital cardiac anomalies, whereas in older children that percentage decreases to 24%.^4,5

Article p 2313

In early stages, heart failure in children is treated pharmacologically, as in adults, although there are comparatively few clinical trial data specific to children.^6–8 As the disease severity increases, definitive therapy of heart failure in children consists of heart transplantation. Approximately 350 pediatric heart transplantations are performed in the United States annually, and, because of a robust national database, outcomes after transplantation are well characterized.⁴ Less is known about outcomes in pediatric patients awaiting heart transplantation. For children, mortality rates of 7% at 30 days have been reported, whereas mortality rate for infants—a uniquely challenging group in terms of donor availability—ranges from 25% to 31% at 6 months in multi-institutional studies.^9–11 Some centers report improved pretransplantation survival in more recent eras as the result of improved medical therapy, innovative strategies to improve the efficiency of donor allocation (eg, ABO incompatible transplantation in infants), and increased use of mechanical support devices in children.^12–15 Because sudden death in children . . . [Full Text of this Article]

Related Article:

Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices: A Multi-Institutional Study

Elizabeth D. Blume, David C. Naftel, Heather J. Bastardi, Brian W. Duncan, James K. Kirklin, Steven A. Webber for the Pediatric Heart Transplant Study Investigators
Circulation 2006 113: 2313-2319. [Abstract] [Full Text]

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				K. Januszewska, E. Malec, J. Birnbaum, M. Loeff, R. Sodian, C. Schmitz, H. Netz, and B. Reichart Ventricular assist device as a bridge to heart transplantation in children Interactive CardioVascular and Thoracic Surgery, November 1, 2009; 9(5): 807 - 810. [Abstract] [Full Text] [PDF]