Researchers at Children's Hospital of Philadelphia (CHOP) pioneered a standardized approach for heart recovery in children using ventricular assist devices (VAD), as reported in the Journal of the American Heart Association. The findings mark a paradigm shift in treatment strategies for severe pediatric heart disease.
The use of VADs in children with severe heart failure is increasing, with more than 1,400 devices placed in more than 1,200 patients across the country between 2018 and 2023. While VAD therapy has traditionally served as a temporary treatment solution until a heart transplant can be performed, recent evidence shows that for certain children VADs can also play a role in helping the heart recover.
In 2022, a multidisciplinary team in the Cardiac Center at CHOP implemented a specialized ventricular recovery program to encourage and identify patients who could benefit from heart recovery with durable VADs. The program consisted of four core components, including the assessment of ventricular recovery for all patients on VAD for consideration of potential explant, universal utilization of reverse remodeling medications, a stepwise evaluation of ventricular function recovery by echocardiography, exercise testing, and catheterization, as well as a multidisciplinary discussion to present findings and solicit input.
The study findings demonstrated that through CHOP's program, 26% of patients were able to have their ventricular assist devices explanted. In the short term, all these patients are doing well, with eight out of nine continuing to live outside the hospital, and one who was ultimately listed for a heart transplant and is now home and thriving after receiving a new heart. More research is needed to understand if similar programs can be implemented at other hospitals, and what the long-term outcomes will be for these children.
“The clinical implications of this approach are significant,” said Jonathan Edelson, MD MSCE, the study’s senior author and Medical Director of the Heart Transplant and Ventricular Assist Device Program at CHOP. “It suggests there may be higher than anticipated rates of heart recovery in children with cardiomyopathy who are supported by VADs and introduces a novel paradigm in which VADs can be thought of as tools for recovery rather than just bridges to heart transplant. Moreover, the standardized evaluation process could facilitate the identification of patients who are candidates for VAD, potentially improving outcomes and quality of life, which is especially important given the limited number of potential heart transplant donors.”
Over the 2-year study period, 35 patients were supported with one of two durable VADs. Underlying indications included cardiomyopathy (60%), congenital heart disease (31%), coronary pathology (6%), and myocarditis (3%).
All children who successfully had their heart assist devices explanted were on multiple medications used to treat heart failure, indicating a potential link that warrants further research. Most recoveries occurred in infants, possibly due to adaptable hearts or shorter heart failure durations prior to device implant. All children showed positive short-term outcomes with no deaths or device re-implantation needed.
“For some families, opting for heart function recovery and device removal is preferable over a heart transplant, despite inherent risks,” said Edelson. “Procedures like cardiac resynchronization therapy during device removal could expand the pool of candidates for this option. This research underscores the need for ongoing evaluation and careful patient selection to improve outcomes for children with severe heart failure, while advocating for innovative approaches and collaborations to boost recovery prospects.”
Edelson et al. “Implementing a Programmatic Approach to Identify and Promote Ventricular Recovery in Pediatric Patients Supported with Ventricular Assist Devices.” J Am Heart Assoc. Online January 22, 2026. DOI: 10.1161/JAHA.125.045453.
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Researchers at Children's Hospital of Philadelphia (CHOP) pioneered a standardized approach for heart recovery in children using ventricular assist devices (VAD), as reported in the Journal of the American Heart Association. The findings mark a paradigm shift in treatment strategies for severe pediatric heart disease.
The use of VADs in children with severe heart failure is increasing, with more than 1,400 devices placed in more than 1,200 patients across the country between 2018 and 2023. While VAD therapy has traditionally served as a temporary treatment solution until a heart transplant can be performed, recent evidence shows that for certain children VADs can also play a role in helping the heart recover.
In 2022, a multidisciplinary team in the Cardiac Center at CHOP implemented a specialized ventricular recovery program to encourage and identify patients who could benefit from heart recovery with durable VADs. The program consisted of four core components, including the assessment of ventricular recovery for all patients on VAD for consideration of potential explant, universal utilization of reverse remodeling medications, a stepwise evaluation of ventricular function recovery by echocardiography, exercise testing, and catheterization, as well as a multidisciplinary discussion to present findings and solicit input.
The study findings demonstrated that through CHOP's program, 26% of patients were able to have their ventricular assist devices explanted. In the short term, all these patients are doing well, with eight out of nine continuing to live outside the hospital, and one who was ultimately listed for a heart transplant and is now home and thriving after receiving a new heart. More research is needed to understand if similar programs can be implemented at other hospitals, and what the long-term outcomes will be for these children.
“The clinical implications of this approach are significant,” said Jonathan Edelson, MD MSCE, the study’s senior author and Medical Director of the Heart Transplant and Ventricular Assist Device Program at CHOP. “It suggests there may be higher than anticipated rates of heart recovery in children with cardiomyopathy who are supported by VADs and introduces a novel paradigm in which VADs can be thought of as tools for recovery rather than just bridges to heart transplant. Moreover, the standardized evaluation process could facilitate the identification of patients who are candidates for VAD, potentially improving outcomes and quality of life, which is especially important given the limited number of potential heart transplant donors.”
Over the 2-year study period, 35 patients were supported with one of two durable VADs. Underlying indications included cardiomyopathy (60%), congenital heart disease (31%), coronary pathology (6%), and myocarditis (3%).
All children who successfully had their heart assist devices explanted were on multiple medications used to treat heart failure, indicating a potential link that warrants further research. Most recoveries occurred in infants, possibly due to adaptable hearts or shorter heart failure durations prior to device implant. All children showed positive short-term outcomes with no deaths or device re-implantation needed.
“For some families, opting for heart function recovery and device removal is preferable over a heart transplant, despite inherent risks,” said Edelson. “Procedures like cardiac resynchronization therapy during device removal could expand the pool of candidates for this option. This research underscores the need for ongoing evaluation and careful patient selection to improve outcomes for children with severe heart failure, while advocating for innovative approaches and collaborations to boost recovery prospects.”
Edelson et al. “Implementing a Programmatic Approach to Identify and Promote Ventricular Recovery in Pediatric Patients Supported with Ventricular Assist Devices.” J Am Heart Assoc. Online January 22, 2026. DOI: 10.1161/JAHA.125.045453.
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