Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective

Background Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures. Aims To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receiv...

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Veröffentlicht in:Seminars in cardiothoracic and vascular anesthesia 2021-09, Vol.25 (3), p.229-238
Hauptverfasser: Newington, Dash F. T., De Rita, Fabrizio, McCheyne, Alan, Barker, Claire Louise
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container_title Seminars in cardiothoracic and vascular anesthesia
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creator Newington, Dash F. T.
De Rita, Fabrizio
McCheyne, Alan
Barker, Claire Louise
description Background Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures. Aims To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease. Methods Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019. Results Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%). Conclusions Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.
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T. ; De Rita, Fabrizio ; McCheyne, Alan ; Barker, Claire Louise</creator><creatorcontrib>Newington, Dash F. T. ; De Rita, Fabrizio ; McCheyne, Alan ; Barker, Claire Louise</creatorcontrib><description>Background Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures. Aims To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease. Methods Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019. Results Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%). Conclusions Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.</description><identifier>ISSN: 1089-2532</identifier><identifier>EISSN: 1940-5596</identifier><identifier>DOI: 10.1177/1089253221998546</identifier><identifier>PMID: 33724075</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><ispartof>Seminars in cardiothoracic and vascular anesthesia, 2021-09, Vol.25 (3), p.229-238</ispartof><rights>The Author(s) 2021</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-fb15fb9ccdcbba5713f66f9144d627317769c2aa1330ea098e6ce9763018a1623</citedby><cites>FETCH-LOGICAL-c337t-fb15fb9ccdcbba5713f66f9144d627317769c2aa1330ea098e6ce9763018a1623</cites><orcidid>0000-0003-3752-488X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1089253221998546$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1089253221998546$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33724075$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Newington, Dash F. T.</creatorcontrib><creatorcontrib>De Rita, Fabrizio</creatorcontrib><creatorcontrib>McCheyne, Alan</creatorcontrib><creatorcontrib>Barker, Claire Louise</creatorcontrib><title>Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective</title><title>Seminars in cardiothoracic and vascular anesthesia</title><addtitle>Semin Cardiothorac Vasc Anesth</addtitle><description>Background Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures. Aims To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease. Methods Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019. Results Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%). Conclusions Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. 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T.</creator><creator>De Rita, Fabrizio</creator><creator>McCheyne, Alan</creator><creator>Barker, Claire Louise</creator><general>SAGE Publications</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3752-488X</orcidid></search><sort><creationdate>20210901</creationdate><title>Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective</title><author>Newington, Dash F. T. ; De Rita, Fabrizio ; McCheyne, Alan ; Barker, Claire Louise</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-fb15fb9ccdcbba5713f66f9144d627317769c2aa1330ea098e6ce9763018a1623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Newington, Dash F. T.</creatorcontrib><creatorcontrib>De Rita, Fabrizio</creatorcontrib><creatorcontrib>McCheyne, Alan</creatorcontrib><creatorcontrib>Barker, Claire Louise</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Seminars in cardiothoracic and vascular anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Newington, Dash F. T.</au><au>De Rita, Fabrizio</au><au>McCheyne, Alan</au><au>Barker, Claire Louise</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective</atitle><jtitle>Seminars in cardiothoracic and vascular anesthesia</jtitle><addtitle>Semin Cardiothorac Vasc Anesth</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>25</volume><issue>3</issue><spage>229</spage><epage>238</epage><pages>229-238</pages><issn>1089-2532</issn><eissn>1940-5596</eissn><abstract>Background Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures. Aims To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease. Methods Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019. Results Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%). Conclusions Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>33724075</pmid><doi>10.1177/1089253221998546</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-3752-488X</orcidid></addata></record>
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