Neurosurgical complications of left ventricular assist devices in children

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Object

Left ventricular assist devices (LVADs) are continuous or pulsatile flow devices that could potentially be life-saving measures for patients with end-stage heart failure. These devices have clear advantages over extracorporeal membrane oxygenation (ECMO) and are often used in adults. They are only recently being commonly used in the pediatric age group. As the use of LVADs becomes more mainstream in children, it is important to determine the complication profile associated with these devices. Furthermore, with the increasing application of LVADs in children, pediatric neurosurgeons are seeing a correlative increase in associated neurological complications. In this study, the authors reviewed the incidence of neurological complications due to LVAD use in the pediatric age group and the role of neurosurgery in treatment.

Methods

The authors examined data regarding patients with LVADs from the Texas Children's Hospital Heart Center database (July 01, 2007, to June 30, 2011) and recorded neurological complications requiring neurosurgical consultation. They identified 2 children who underwent craniotomies during LVAD treatment.

Results

Intracranial hemorrhage occurred in 3 (6.5%) of the 46 patients treated with an LVAD at the authors' institution. Of these patients, 2 were treated with craniotomies for life-threatening intracranial hemorrhages. The 3 patients in the neurosurgical cohort presented with cerebral infarction, decreased level of consciousness, and/or seizure. At the last follow-up (286, 503, and 550 days), 1 patient (Case 2) had no decline in neurological status, underwent a successful heart transplant, and was discharged home; 1 patient (Case 1) died of refractory cardiac failure; and 1 patient (Case 3) was on an LVAD for destination therapy (that is, the LVAD is not a bridge to transplantation but rather the final treatment). This patient was discharged from the hospital, but he died of overwhelming fungemia at 286 days while on VAD support.

Conclusions

Intracranial hemorrhage is a serious and feared complication of LVAD treatment. While the surgical risk is substantial due to systemic anticoagulation and significant medical comorbidities, neurosurgical evacuation of hemorrhage plays an important life-saving role that can yield successful and acceptable outcomes.

Abbreviations used in this paper:ECMO = extracorporeal membrane oxygenation; ICH = intracranial hemorrhage; LVAD = left ventricular assist device; SDH = subdural hematoma.
Article Information

Contributor Notes

Address correspondence to: Andrew Jea, M.D., Division of Pediatric Neurosurgery, Texas Children's Hospital, 6621 Fannin Street, CCC 1230.01, 12th Floor, Houston, Texas 77030. email: ahjea@texaschildrenshospital.org.Please include this information when citing this paper: published online August 31, 2012; DOI: 10.3171/2012.7.PEDS12161.
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References
  • 1

    Adachi IFraser CD Jr: Mechanical circulatory support for infants and small children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 14:38442011

    • Search Google Scholar
    • Export Citation
  • 2

    Amodeo ABrancaccio GMichielon GFilippelli SRicci ZMorelli S: Pneumatic pulsatile ventricular assist device as a bridge to heart transplantation in pediatric patients. Artif Organs 34:101710222010

    • Search Google Scholar
    • Export Citation
  • 3

    Arabía FATsau PHSmith RGNolan PEParamesh VBose RK: Pediatric bridge to heart transplantation: application of the Berlin Heart, Medos and Thoratec ventricular assist devices. J Heart Lung Transplant 25:16212006

    • Search Google Scholar
    • Export Citation
  • 4

    Ashton RC JrOz MCMichler REChampsaur GCatanese KAHsu DT: Left ventricular assist device options in pediatric patients. ASAIO J 41:M277M2801995

    • Search Google Scholar
    • Export Citation
  • 5

    Cassidy JHaynes SKirk RCrossland DSmith JHHamilton L: Changing patterns of bridging to heart transplantation in children. J Heart Lung Transplant 28:2492542009

    • Search Google Scholar
    • Export Citation
  • 6

    Chang ACMcKenzie ED: Mechanical cardiopulmonary support in children and young adults: extracorporeal membrane oxygenation, ventricular assist devices, and long-term support devices. Pediatr Cardiol 26:2282005

    • Search Google Scholar
    • Export Citation
  • 7

    Davies RRRusso MJHong KNO'Byrne MLCork DPMoskowitz AJ: The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: an analysis of the United Network for Organ Sharing database. J Thorac Cardiovasc Surg 135:4214272008

    • Search Google Scholar
    • Export Citation
  • 8

    del Nido PJArmitage JMFricker FJShaver MCipriani LDayal G: Extracorporeal membrane oxygenation support as a bridge to pediatric heart transplantation. Circulation 90:II66II691994

    • Search Google Scholar
    • Export Citation
  • 9

    Duncan BW: Mechanical circulatory support for infants and children with cardiac disease. Ann Thorac Surg 73:167016772002

  • 10

    Factora FNBustamante SSpiotta AAvitsian R: Intracranial hemorrhage surgery on patients on mechanical circulatory support: a case series. J Neurosurg Anesthesiol 23:30342011

    • Search Google Scholar
    • Export Citation
  • 11

    Garcia-Guereta LCabo Jde la Oliva PVillar MABronte LDGoldman L: Ventricular assist device application with the intermediate use of a membrane oxygenator as a bridge to pediatric heart transplantation. J Heart Lung Transplant 28:7407422009

    • Search Google Scholar
    • Export Citation
  • 12

    Goldman APCassidy Jde Leval MHaynes SBrown KWhitmore P: The waiting game: bridging to paediatric heart transplantation. Lancet 362:196719702003

    • Search Google Scholar
    • Export Citation
  • 13

    Hetzer RLoebe MPotapov EVWeng YStiller BHennig E: Circulatory support with pneumatic paracorporeal ventricular assist device in infants and children. Ann Thorac Surg 66:149815061998

    • Search Google Scholar
    • Export Citation
  • 14

    Hetzer RPotapov EVStiller BWeng YHübler MLemmer J: Improvement in survival after mechanical circulatory support with pneumatic pulsatile ventricular assist devices in pediatric patients. Ann Thorac Surg 82:9179252006

    • Search Google Scholar
    • Export Citation
  • 15

    Holman WLBourge RCSpruell RDMurrah CPMcGiffin DCKirklin JK: Ventricular assist devices as a bridge to cardiac transplantation. A prelude to destination therapy. Ann Surg 225:6957061997

    • Search Google Scholar
    • Export Citation
  • 16

    Humpl TFurness SGruenwald CHyslop CVan Arsdell G: The Berlin Heart EXCOR Pediatrics—The SickKids Experience 2004–2008. Artif Organs 34:108210862010

    • Search Google Scholar
    • Export Citation
  • 17

    Ibrahim AEDuncan BWBlume EDJonas RA: Long-term follow-up of pediatric cardiac patients requiring mechanical circulatory support. Ann Thorac Surg 69:1861922000

    • Search Google Scholar
    • Export Citation
  • 18

    Lazar RMShapiro PAJaski BEParides MKBourge RCWatson JT: Neurological events during long-term mechanical circulatory support for heart failure: the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) experience. Circulation 109:242324272004

    • Search Google Scholar
    • Export Citation
  • 19

    Malaisrie SCPelletier MPYun JJSharma KTimek TARosenthal DN: Pneumatic paracorporeal ventricular assist device in infants and children: initial Stanford experience. J Heart Lung Transplant 27:1731772008

    • Search Google Scholar
    • Export Citation
  • 20

    Owens WRBryant R IIIDreyer WJPrice JFMorales DL: Initial clinical experience with the HeartMate II ventricular assist system in a pediatric institution. Artif Organs 34:6006032010

    • Search Google Scholar
    • Export Citation
  • 21

    Pollock JCCharlton MCWilliams WGEdmonds JFTrusler GA: Intraaortic balloon pumping in children. Ann Thorac Surg 29:5225281980

    • Search Google Scholar
    • Export Citation
  • 22

    Potapov EVStiller BHetzer R: Ventricular assist devices in children: current achievements and future perspectives. Pediatr Transplant 11:2412552007

    • Search Google Scholar
    • Export Citation
  • 23

    Reinhartz OKeith FMEl-Banayosy AMcBride LRRobbins RCCopeland JG: Multicenter experience with the thoratec ventricular assist device in children and adolescents. J Heart Lung Transplant 20:4394482001

    • Search Google Scholar
    • Export Citation
  • 24

    Rose EAGelijns ACMoskowitz AJHeitjan DFStevenson LWDembitsky W: Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 345:143514432001

    • Search Google Scholar
    • Export Citation
  • 25

    Samuels LEKohout JCasanova-Ghosh EHagan KGarwood PFerdinand F: Argatroban as a primary or secondary postoperative anticoagulant in patients implanted with ventricular assist devices. Ann Thorac Surg 85:165116552008

    • Search Google Scholar
    • Export Citation
  • 26

    Spanier TOz MLevin HWeinberg AStamatis KStern D: Activation of coagulation and fibrinolytic pathways in patients with left ventricular assist devices. J Thorac Cardiovasc Surg 112:109010971996

    • Search Google Scholar
    • Export Citation
  • 27

    Spanier TBChen JMOz MCStern DMRose EASchmidt AM: Time-dependent cellular population of textured-surface left ventricular assist devices contributes to the development of a biphasic systemic procoagulant response. J Thorac Cardiovasc Surg 118:4044131999

    • Search Google Scholar
    • Export Citation
  • 28

    Stiller BWeng YHübler MLemmer JNagdyman NRedlin M: Pneumatic pulsatile ventricular assist devices in children under 1 year of age. Eur J Cardiothorac Surg 28:2342392005

    • Search Google Scholar
    • Export Citation
  • 29

    Tschirkov ANikolov DPapantchev V: The Berlin Heart EXCOR in an 11-year-old boy: a bridge to recovery after myocardial infarction. Tex Heart Inst J 34:4454482007

    • Search Google Scholar
    • Export Citation
  • 30

    US Food and Drug Administration: FDA approves mechanical cardiac assist device for children with heart failure (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm283956.htm) [Accessed August 3 2012]

    • Search Google Scholar
    • Export Citation
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