St. Louis Children’s Hospital is internationally recognized as pioneers in the use of mechanical assist devices - also known as ventricular assist devices - to support heart function in infants and children. Our pediatric heart specialists at the St. Louis Children’s and Washington University Heart Center maintain a robust mechanical assist devices program providing expert care for children from the St. Louis area and surrounding states.
What is a Mechanical Assist Device?
- A mechanical assist device is a mechanical pump that supports heart function and blood flow in children with heart disease when their heart cannot support them alone.
- These devices can be used in children with both diseases of heart muscle, called cardiomyopathies, and some types of congenital heart disease.
- While these devices are not without risk, they can be life-saving in children with significant heart disease.
Ventricular Assist Devices
There are several types of devices that can be used in children, depending on their size and anatomy. When placed in the pumping chamber of the heart, called a ventricle, these devices are called Ventricular Assist Devices (VADs).
- Berlin Excor device
- Heartware HVAD device
- Centrimag and Pedimag
Who May Need a Ventricular Assist Device?
The decision to use a ventricular assist device involves discussion with the medical team and family to determine the best way to support in a child with heart disease. Some situations in which a ventricular assist device may be used include:
- As a way to support the heart and blood flow while a child awaits heart transplant or recovery in some instances.
- In some cases, devices are used after complex heart surgery until the heart recovers. In some instances, ventricular assist devices may be used to support patients longer term when heart transplant is not an option.
What is Life Like on a Ventricular Assist Device?
While Ventricular Assist Devices may be used to support children with different types of heart disease, the goals while on device support are similar for all children:
- Rehabilitation with focus on improving strength, movement, and development
- Improving overall nutrition with good weight gain
- Reduction of other medical support as tolerated, such as sedation medications and respiratory (breathing) support
- Depending on the age and type of device, discharge from the hospital
- Daily medications to ensure proper function of the device
What are the risks of a Ventricular Assist Device?
Although Ventricular Assist Devices may be beneficial and lifesaving, there are important risks that are discussed with the medical team, patients, and families. These risks may vary depending on a child’s heart disease diagnosis, type of device, and body size. Some of the more commonly reported risks in children on devices include:
- Bleeding or clot in the brain (stroke)
- Bleeding in the gastrointestinal (GI) tract or other organs
- Infection, such as in skin, wounds, or blood
St. Louis Children’s Hospital is part of several nation-wide groups of medical professionals who work together to improve outcomes in children with mechanical assist devices.
- ACTION Learning Network: Multi-institutional network of physicians, nurses, perfusionists and families working to improve education and outcomes in children supported with mechanical assist devices.
- Pedimacs registry: Multi-institutional registry with goal of collecting data and fueling research on mechanical assist device use in children to improve outcomes.
Ventricular Assist Device support: What to expect?
- A detailed conversation with your child’s surgeon and advanced support cardiologist about decision to place a ventricular assist device, including potential risks and benefits specific to your child’s heart disease
- Availability 24 hours a day, 7 days a week, 365 days a year for expert ventricular assist device care while in or out of the hospital
- Close coordination with your referring pediatric cardiologist
- Extensive teaching for family members and, when appropriate, your child for care and management while on device support
- Community outreach VAD education support will be provided for our patients who are able to be discharged home on device support. Including, but not limited to:
- Staff at your child’s school, including teachers, coaches, the principal and nurses
- Your family doctor and referring cardiologist
- Your community’s fire department and other emergency responders
Ventricular Assist Device support at The Heart Center: Why Choose Us?
- The St. Louis Children’s and Washington University Heart Center is a nationally recognized Mechanical Assist Device program. That means you have access to some of the foremost leaders in device support research and treatment.
- With the largest pediatric heart team in the St. Louis area, we are dedicated to high-quality and compassionate care for children with heart disease.
- Our ongoing collaborations and quality improvement programs support our commitment to providing excellent outcomes for our patients.
- When we treat your child with a mechanical assist device, we begin a partnership with you using a holistic, multi-disciplinary team approach to support the whole child and family.
What makes our team unique?
- St. Louis Children’s Hospital was one of the first hospitals in the Midwest to offer mechanical assist device support for children.
- St. Louis Children’s Hospital’s Mechanical Assist Device Program has been continuous since 1993.
- We participated in the groundbreaking Berlin EXCOR pediatric trial in 2005.
- To date we have done over 50 Berlin Heart EXCOR devices, approximately 30 PediMag/CentriMag devices, and over 20 Heartware HVAD devices.
- We have supported over 20 patients with single ventricle physiology.
- For children with devices eligible for going home, the majority of children are able to be discharged from the hospital to locally or home.
- We have a robust Extra Corporeal Membrane Oxygenation (ECMO) transport program to transport critically ill children on ECMO support to St. Louis Children’s Hospital for further support.