Korean Circ J.  2015 Jan;45(1):1-8. 10.4070/kcj.2015.45.1.1.

Pediatric Heart Failure: Current State and Future Possibilities

• Rossano JW
• Jang GY

• KMID: 2223839
• DOI: http://doi.org/10.4070/kcj.2015.45.1.1

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).

Keyword

Pediatrics; Heart failure; Ventricular assist device

MeSH Terms

Adult
Cardiomyopathies
Child
Heart
Heart Defects, Congenital
Heart Failure*
Heart Transplantation
Heart-Assist Devices
Humans
Infant
Mortality
Myocarditis
Pediatrics

Figure

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  Fig. 1 Hospital mortality of children with heart failure related hospitalizations. *Significantly increased hospital mortality (p<0.05). HTN: hypertension, CVD: cerebrovascular disease, ECMO: extra corporeal membrane oxygenation, VAD: ventricular assist device. Adopted from Rossano JW, et al. with permission from the publisher.10)

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  Fig. 2 Freedom from death or transplantation for patients with pure dilated cardiomyopathy. Retrospective cohort diagnosed 1990-1995; Prospective cohort diagnosed 1996-2002. Adopted from Towbin JA, et al. with permission from the publisher.17)

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  Fig. 3 The Berlin Heart Excor (Berlin Heart Inc.) ventricular assist device. Reproduced with permission from the company. A: application in failing heart. B: magnification of device.

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  Fig. 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)

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  Fig. 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)

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