Pediatric ventricular assist devices: current challenges and future prospects.
Pediatric ventricular assist devices: current challenges and future prospects.
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DOI：
10.2147/vhrm.s82379
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发表时间：
2017
影响因子：
2.9
通讯作者：
Adachi I
中科院分区：
文献类型：
--
作者：
Burki S;Adachi I
在过去的二十年里，机械循环支持领域取得了巨大的进步。虽然儿童的机械循环支持落后于成人，但两者之间的差距有望很快缩小。目前唯一被美国食品和药物管理局批准用于儿童的设备是柏林心脏EXCOR心室辅助装置（VAD）。前瞻性柏林心脏研究装置豁免试验显示，约90%的儿童支持该装置，结果良好，如移植或恢复的桥梁。然而，也注意到出血性和血栓性并发症的高发。因此，儿科中心刚刚开始在儿童体内植入成人体内连续血流装置。这种模式的转变开启了儿科机械循环支持的新时代。虽然VAD患儿以前仅在医院接受治疗，但诸如门诊管理甚至目的地治疗等治疗选择已成为现实。随着不断小型化和技术改进，目前正在开发的设备将扩大儿童可选择的范围。HeartMate 3和HeartWare MVAD就是两个这样的紧凑型vad，预计在儿科使用方面具有很大的潜力。此外，新设计的儿科专用连续流VAD Jarvik Infant 2015目前正在进行临床前测试，预计将在不久的将来进行随机临床试验。本文旨在讨论成人体内连续血流装置在儿童中的应用所面临的挑战，并对儿童VADs领域的未来前景提出展望。
The field of mechanical circulatory support has made great strides in the preceding 2 decades. Although pediatric mechanical circulatory support has lagged behind that of adults, the gap between them is expected to close soon. The only device currently approved by the US Food and Drug Administration for use in children is the Berlin Heart EXCOR ventricular assist device (VAD). The prospective Berlin Heart Investigational Device Exemption Trial demonstrated good outcomes, such as bridge to transplantation or recovery, in ~90% of children supported with this device. However, a high incidence of hemorrhagic and thrombotic complications was also noted. As a result, pediatric centers have just started implanting adult intracorporeal continuous-flow devices in children. This paradigm shift has opened a new era in pediatric mechanical circulatory support. Whereas children on VAD were previously managed exclusively in hospital, therapeutic options such as outpatient management and even destination therapy have been becoming a reality. With continued miniaturization and technological refinements, devices currently in development will broaden the range of options available to children. The HeartMate 3 and HeartWare MVAD are two such compact VADs, which are anticipated to have great potential for pediatric use. Additionally, a pediatric-specific continuous-flow VAD, the newly redesigned Jarvik Infant 2015, is currently undergoing preclinical testing and is expected to undergo a randomized clinical trial in the near future. This review aims to discuss the challenges posed by the use of intracorporeal adult continuous-flow devices in children, as well as to provide our perspective on the future prospects of the field of pediatric VADs.