Miniaturized Implantable VAD Alleviates Pediatric Heart Failure

A minute axial-flow ventricular assist device (VAD) offers hope in the management of severe heart failure (HF) in small children.

The Infant Jarvik 2015 is an implantable VAD that offers up to three liters per minute flow rate. To test the VAD, researchers at Texas Children's Hospital (Houston, USA), implanted it in ten sheep, with the outflow graft attached to the proximal descending aorta. Results showed that eight of the ten sheep completed the study and remained in good health, as indicated by appropriate weight gain over a period of one to two months. The remaining two animals did not complete the study due to complications that were not directly related to the pump.

The most significant finding was very minimal red blood cell (RBC) hemolysis, despite the high pump speed of up to 18,000 revolutions per minute (RPM). The entire VAD pathway was clean, without thrombi or fibrin deposits, except in one sheep. In six animals, there were small kidney infarcts. The study was presented at the 96th annual meeting of the American Association for Thoracic Surgery (AATS), held during May 2016 in Baltimore (MD, USA).

"This preclinical study not only demonstrates the clinical feasibility of the new device, it also provides important insights into how this device may be managed when used clinically in pediatric patients," said lead investigator Iki Adachi, MD. " This study will be an important milestone in the new era of pediatric heart failure management with implantable VADs."

VADs have become the standard of care in the management of severe HF. But while in adults, implantable VADs, usually axial, are used exclusively no implantable VADs until now have been designed specifically for small children. The result is that the vast majority of pediatric patients with severe HF are managed with paracorporeal (external) VADs, which in general are associated with higher risk profiles and require hospital management.

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Texas Children's Hospital