{"id":30963,"date":"2012-08-08T19:31:56","date_gmt":"2012-08-08T23:31:56","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=30963"},"modified":"2012-08-08T19:31:56","modified_gmt":"2012-08-08T23:31:56","slug":"risks-and-benefits-of-pediatric-vad-explored","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/08\/08\/risks-and-benefits-of-pediatric-vad-explored\/","title":{"rendered":"Risks and Benefits of Pediatric VAD Explored"},"content":{"rendered":"<p>Few options besides extracorporeal membrane oxygenation (ECMO) have been available for children with systolic heart failure awaiting transplantation. Now, <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1014164\">a report by Charles Fraser, Jr., and colleagues published in the\u00a0<\/a><em><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1014164\">New England Journal of Medicine<\/a><\/em>\u00a0provides important new information about a ventricular assist device (VAD) designed for children.<\/p>\n<p>Trial investigators implanted 48 patients with the Excor Pediatric VAD (Berlin Heart) and compared them with matched historical controls who had received ECMO. The VAD group comprised two 24-patient cohorts based on body-surface area. Survival was dramatically and significantly longer in both VAD cohorts:<\/p>\n<ul>\n<li>Cohort 1 (body surface area, &lt;0.7 m<sup>2<\/sup>):\u00a0 the median survival time in the VAD group had not yet been reached at 174 days, while the median survival time with ECMO was 13 days (p&lt;0.001)<\/li>\n<li>Cohort 2 (0.7 to &lt;1.5 m<sup>2<\/sup>): median survival: 114 days with VAD versus 10 days with ECMO (p&lt;0.001)<\/li>\n<\/ul>\n<p>However, VAD treatment was associated with clinically significant adverse events. Major bleeding occurred in 42% of cohort 1 patients and 50% of cohort 2 patients, infection in 63% and 50%, and stroke occurred in 29% of patients in each cohort.<\/p>\n<p>In\u00a0<a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMe1206893\">an accompanying editorial<\/a>,\u00a0Linda Addonizio\u00a0observes that the development of pediatric VADs has been markedly slower than the development of adult VADs, although &#8220;the potential number of years of life saved for each person is much greater for children.&#8221; However, because of the high rate of neurological complications, she urges caution before &#8220;extending the current practice in adults of early\u00a0implementation of ventricular assist devices to\u00a0children.&#8221; VADs, she writes, &#8220;should remain, at present, a last resort\u00a0in small children.&#8221;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Few options besides extracorporeal membrane oxygenation (ECMO) have been available for children with systolic heart failure awaiting transplantation. Now, a report by Charles Fraser, Jr., and colleagues published in the\u00a0New England Journal of Medicine\u00a0provides important new information about a ventricular assist device (VAD) designed for children. Trial investigators implanted 48 patients with the Excor Pediatric [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20,14],"tags":[555,1399,1067,773],"class_list":["post-30963","post","type-post","status-publish","format-standard","hentry","category-cardiac-surgery","category-heart-failure","tag-bridge-to-transplant","tag-ecmo","tag-pediatrics","tag-vads"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/30963","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=30963"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/30963\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=30963"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=30963"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=30963"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}