LVAD as a Bridge to Recovery in Young Children with Cardiomyopathy: A Longitudinal Echocardiographic Study

  • Chelsea Knudson, University of Arizona College of Medicine, United States
  • Dr Hannah Zimmerman, University of Arizona Department of Surgery, United States
  • Dr Jack Copeland, University of Arizona Department of Surgery Section of Cardiothoracic Surgery, United States
  • Dr Daniela Lax, University of Arizona Department of Pediatrics Section of Pediatric Cardiology, United States
  • Diane Covington, University of Arizona Marshall Foundation Artificial Heart Lab, United States
  • Richard Smith, University Medical Center, United States
  • Dr Brian Blair, University of Arizona Department of Pediatrics Section of Pediatric Cardiology, United States
  • Dr Brent Barber, University of Arizona Department of Pediatrics Section of Pediatric Cardiology, United States

    • Objective: Echocardiographic follow-up of young children who were successfully weaned from left ventricular assist device (LVAD).
    Methods: Children with dilated cardiomyopathy failing maximal inotropic support were placed on LVADs. They were followed longitudinally with multiple echo studies.
    Results: A total of 26 children were placed on mechanical circulatory support, 14 were transplanted and 12 (46%) demonstrated left ventricular (LV) recovery. Eight (67%) of the 12 were weaned off mechanical support and discharged home, 1 was weaned and subsequently transplanted, 2 died in the hospital after weaning, and 1 had LV recovery, but died prior to device explantation.
    Of the 12 patients, 9 (75%) were female, the median age was 12 months (1-72 months), and the mean weight 8.5 kg (mean BSA= 0.42m2). Devices implanted included: MEDOS, Berlin, and Jostra, with a mean duration of support of 16.5 days (2-70 days).
    The following echo parameters were followed:
    Pre LVAD: LV diameter end diastole (LVED) Z score= + 5.3-14.6 (mean = +10.5); Fractional Shortening (FS) = 8-13% (mean 9%); 90% had mild-severe mitral regurgitation (MR), and 70% had mild-moderate tricuspid regurgitation (TR).
    Post LVAD:(1-57 months [mean 22, median 17] post LVAD wean): LVED Z score significantly improved to +1-8.4; (mean +5; p=0.0001); FS improved (mean 33%); and MR (trace 66%) and TR (trace 55%) also improved.
    Conclusions: We report the successful weaning of children ≤ 6 years of age from LVAD and the echocardiographic demonstration of reverse remodeling with improvements in LV dimension, function and AV valve regurgitation.