Background: Ventricular assist devices (VAD) are increasingly being used in children with end-stage heart failure requiring or medium- and long-term support. We analyzed the development of our clinical practice with pediatric VAD over 19 years.

Methods: Since 1990, 102 VAD have been implanted in 99 patients (<18 yrs) at our institution (Berlin Heart Excor n=100, BH Incor n=1 and Novacor n=1). This cohort was divided in two groups: Period I – devices implanted between 1990 and 2002 (n=46) and Period II – devices implanted since 2002 (n=56), and the outcome of both groups was compared.

Results: There were no significant differences in the preoperative patient data except for time of support (Period I, median 10 days (range 0-591) vs. Period II, 37 (1-420 days), p<0.001). In period I more patients were supported with a biventricular VAD, 64%, vs. 26%, p<0.001). In the later period more children were extubated while on the VAD (38% vs. 62%, p=0.02). Hospital discharge following either weaning from the system or heart transplantation was achieved in 49% during period I and in 70% during period II (p=0.035), and an increasing proportion of those was < 1 yr old (8% vs. 44%, p= 0.088). Moreover, the discharge rate of patients with postcardiotomy heart failure improved (17% vs. 80% p=0.028).

Conclusion: Earlier implantation, device modifications, and improvements in the anticoagulation monitoring regime have led to a significant increase in the survival and discharge rate of children on VADs, especially those under 1 year of age.