What is a Ventricular Assist Device (VAD)?

A ventricular assist device, or VAD, is a type of mechanical circulatory support used in children and adults with heart failure. When the heart is unable to pump enough blood to meet the body’s needs, a VAD can help. This mechanical device is often used as a bridge to heart transplant – supporting the heart’s function while a patient in heart failure waits for a donor organ. However, it can also be used as a bridge to recovery, allowing a patient’s heart to heal until additional support is no longer needed. 

Who is a candidate for a VAD?

Children with heart failure whose heart function can’t be supported with medication alone may be considered candidates for a ventricular assist device (VAD) while waiting for further treatment, such as surgery, a heart transplant or possible recovery of heart function.

This may include patients who have:

• An acute heart injury caused by an infection, such as myocarditis
• A heart muscle condition known as cardiomyopathy (most often dilated cardiomyopathy)
• A prolonged arrhythmia, or abnormal heart rhythm, that weakens the heart muscle over time
• Congenital heart disease (both single-ventricle and complex two-ventricle conditions), including patients with complex heart anatomy who are not candidates for surgery and whose condition is expected to progress to heart failure requiring a transplant

What types of VADS are available?

The Heart Function, Transplant and Ventricular Assist Device team at Children’s Hospital of Philadelphia (CHOP) has special expertise in a wide range of ventricular assist devices. The specific device used for your child will depend on a variety of factors, including weight and condition, as well as the purpose of mechanical circulatory support and how long your child is expected to need it. In some cases, VAD placement is also combined with other innovative surgical interventions, such as the hybrid VAD.

The ventricular assist devices used for children at CHOP include:

Impella^®

The Impella^® is a continuous-flow ventricular assist device. This means it moves blood continuously from the left ventricle (the heart’s main pumping chamber) to the aorta, helping maintain steady and effective circulation.

The Impella^® is used in adults and larger children who weigh at least 65 pounds. Because it is very small, doctors can place it through a small incision without opening the chest. It provides short-term support for patients with acute heart failure and can be used as a bridge to transplant or as a bridge to recovery.

CentriMag™

The CentriMag™ is another continuous-flow device, designed for infants and children who weigh less than 55 pounds. It provides short-term circulatory support for patients in acute heart failure. 

Berlin Heart^®

The Berlin Heart^® is a durable, pulsatile VAD — meaning it mimics the natural heartbeat by pushing blood out in beats or pulses. It was developed specifically for infants and children under 55 pounds.

This device is very versatile. It can support one side of the heart (a left ventricular assist device, or LVAD) or both sides (a biventricular assist device, or BiVAD). The Berlin Heart requires open-heart surgery to implant. The tubes (called cannulas) are connected to the heart and major blood vessels, while the actual blood pumps remain outside the body. Because of this, patients need to stay in the hospital while receiving Berlin Heart^® support.

CHOP is part of a clinical trial for the EXCOR^® Active, a mobile driving unit for the Berlin Heart^®. This device gives patients more freedom of movement and may one day make it possible for some children to receive Berlin Heart® support at home.

HeartMate 3™ LVAD

The HeartMate 3™ LVAD is another continuous-flow device used in patients who weigh more than 55 pounds. It is currently the only LVAD that allows patients to receive VAD support at home.

Being able to go home with a VAD offers many benefits. Patients can return to their normal routines, spend more time with family, and take part in everyday activities while still receiving the heart support they need. This often leads to a better quality of life and improved emotional well-being compared to staying in the hospital for an extended time.

The HeartMate 3™ can be used as a bridge to recovery or to transplant. For patients who are not candidates for transplant, it can also serve as destination therapy, or long-term heart support, for patients living with advanced heart failure.