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.
At Children’s Hospital of Philadelphia (CHOP), experts in the Heart Function, Transplant and Ventricular Assist Device Program are developing new and innovative ways to use mechanical circulatory support like VADs. Katsuhide Maeda, MD, PhD, is the Director of Mechanical Circulatory Support and ECMO, the Surgical Director of Cardiac Lymphatics, and the Surgical Director of the Heart and Lung Transplant Program at CHOP. Here, he discusses the types and function of VADs used at CHOP and what makes CHOP’s approach to heart failure different from that of other institutions.
Q: CHOP is known for pioneering innovative approaches to pediatric cardiac care. How does your team’s approach to the use of VADs differ from other hospitals?
A. Many institutions have a limited selection of ventricular assist devices. They are also less likely to use a VAD in babies or in children with complex heart anatomies. At CHOP, we not only use a wide range of devices, but we are also dedicated to innovation in surgical technique. An example of this is a recent case where we removed a patient’s entire heart and used a biventricular (both sides of the heart) assist device to completely support circulation until transplant.
We are also very focused on using VADs to expedite the recovery of the heart so a patient doesn’t need a transplant. In these cases, the VAD supports heart function while a patient is treated with medication. Once the heart has recovered proper function, we explant (remove) the VAD.
The really unique thing about our program is the specialized care we provide for patients with heart failure. We have a dedicated Heart Failure Intensive Care Unit with an experienced team of surgical, medical, rehabilitation and ICU providers, so our patients get all of the care they need in one place.
Q. What are the different types of VADs available at CHOP?
A. Although we work with a variety of mechanical circulatory support devices, the specific device chosen for an individual patient will depend on the patient’s size and condition, as well the purpose of mechanical circulatory support and how long the patient is expected to need it.
The Impella® is a continuous flow ventricular device assist device, meaning the blood flows continuously from the left ventricle to the aorta, leading to stable and effective circulation. It is used in adults and larger children, weighing at least 65 pounds. The device is small enough that we can implant it through a small incision and don’t have to open the chest. It provides temporary support for patients with acute heart failure and can be used as a bridge to transplant or to recovery.
The CentriMag™ is another continuous flow device used to temporarily support infants and children under 55 pounds. It’s used for short-term circulatory support for patients in acute heart failure.
The Berlin Heart® is a durable, pulsatile (mimics the natural heartbeat by pushing blood out in beats or pulses) VAD, specifically developed for infants or children under 55 pounds. It’s a very versatile device and can be used to support one ventricle (left-sided or LVAD) or both ventricles (bilateral or BiVAD). The Berlin requires open-heart surgery to implant. We connect the tubes (or cannulas) to the heart and major blood vessels, but the actual blood pumps are located outside of the body. This means the patient has to stay in the hospital while receiving VAD support. CHOP is currently part of a clinical trial for the EXCOR® Active, a mobile driving unit that allows VAD patients more mobility and could potentially allow for home use in the future.
The HeartMate 3™ LVAD is another continuous flow device used in patients weighing more than 55 pounds. This is currently the only LVAD that enables patients to receive VAD support at home. We are very aggressive about using it if at all possible because patients who are discharged home have a better quality of life than those who have to stay in the hospital. The HeartMate 3™ can be used as a bridge to recovery or to transplant. For patients who aren’t candidates for transplant, the HeartMate 3™ can also be used as destination therapy, which means long-term heart support, for patients living with advanced heart failure.
Q. Looking ahead, what innovations in VAD technology are you most excited about?
A. Heart transplants can be a good option when a patient is a candidate, but they also come with the risk of organ rejection. Transplant patients have to take immunosuppressants for the rest of their lives. VADs don’t require immunosuppressants. I believe that the future of heart failure therapy is in VADs and that we’ll get better and better at using them as destination therapy.
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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.
At Children’s Hospital of Philadelphia (CHOP), experts in the Heart Function, Transplant and Ventricular Assist Device Program are developing new and innovative ways to use mechanical circulatory support like VADs. Katsuhide Maeda, MD, PhD, is the Director of Mechanical Circulatory Support and ECMO, the Surgical Director of Cardiac Lymphatics, and the Surgical Director of the Heart and Lung Transplant Program at CHOP. Here, he discusses the types and function of VADs used at CHOP and what makes CHOP’s approach to heart failure different from that of other institutions.
Q: CHOP is known for pioneering innovative approaches to pediatric cardiac care. How does your team’s approach to the use of VADs differ from other hospitals?
A. Many institutions have a limited selection of ventricular assist devices. They are also less likely to use a VAD in babies or in children with complex heart anatomies. At CHOP, we not only use a wide range of devices, but we are also dedicated to innovation in surgical technique. An example of this is a recent case where we removed a patient’s entire heart and used a biventricular (both sides of the heart) assist device to completely support circulation until transplant.
We are also very focused on using VADs to expedite the recovery of the heart so a patient doesn’t need a transplant. In these cases, the VAD supports heart function while a patient is treated with medication. Once the heart has recovered proper function, we explant (remove) the VAD.
The really unique thing about our program is the specialized care we provide for patients with heart failure. We have a dedicated Heart Failure Intensive Care Unit with an experienced team of surgical, medical, rehabilitation and ICU providers, so our patients get all of the care they need in one place.
Q. What are the different types of VADs available at CHOP?
A. Although we work with a variety of mechanical circulatory support devices, the specific device chosen for an individual patient will depend on the patient’s size and condition, as well the purpose of mechanical circulatory support and how long the patient is expected to need it.
The Impella® is a continuous flow ventricular device assist device, meaning the blood flows continuously from the left ventricle to the aorta, leading to stable and effective circulation. It is used in adults and larger children, weighing at least 65 pounds. The device is small enough that we can implant it through a small incision and don’t have to open the chest. It provides temporary support for patients with acute heart failure and can be used as a bridge to transplant or to recovery.
The CentriMag™ is another continuous flow device used to temporarily support infants and children under 55 pounds. It’s used for short-term circulatory support for patients in acute heart failure.
The Berlin Heart® is a durable, pulsatile (mimics the natural heartbeat by pushing blood out in beats or pulses) VAD, specifically developed for infants or children under 55 pounds. It’s a very versatile device and can be used to support one ventricle (left-sided or LVAD) or both ventricles (bilateral or BiVAD). The Berlin requires open-heart surgery to implant. We connect the tubes (or cannulas) to the heart and major blood vessels, but the actual blood pumps are located outside of the body. This means the patient has to stay in the hospital while receiving VAD support. CHOP is currently part of a clinical trial for the EXCOR® Active, a mobile driving unit that allows VAD patients more mobility and could potentially allow for home use in the future.
The HeartMate 3™ LVAD is another continuous flow device used in patients weighing more than 55 pounds. This is currently the only LVAD that enables patients to receive VAD support at home. We are very aggressive about using it if at all possible because patients who are discharged home have a better quality of life than those who have to stay in the hospital. The HeartMate 3™ can be used as a bridge to recovery or to transplant. For patients who aren’t candidates for transplant, the HeartMate 3™ can also be used as destination therapy, which means long-term heart support, for patients living with advanced heart failure.
Q. Looking ahead, what innovations in VAD technology are you most excited about?
A. Heart transplants can be a good option when a patient is a candidate, but they also come with the risk of organ rejection. Transplant patients have to take immunosuppressants for the rest of their lives. VADs don’t require immunosuppressants. I believe that the future of heart failure therapy is in VADs and that we’ll get better and better at using them as destination therapy.
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