Cardiac transplantation and ventricular assist devices

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Target exams

Red flags

• A child on maximal medical heart-failure therapy who is still symptomatic, losing weight or developing end-organ dysfunction is refractory and must be referred urgently to an advanced heart-failure and transplant centre — the goal of every device and listing decision is to transplant before irreversible pulmonary vascular or renal injury
• An INTERMACS profile 1 (critical cardiogenic shock, 'crash-and-burn') child has the highest short-term mortality on a ventricular assist device — early short-term mechanical circulatory support such as VA-ECMO is used to stabilise the candidate before a durable device or transplant
• Stroke is the dominant complication of the Berlin Heart EXCOR and other paediatric ventricular assist devices and is the leading cause of death on support — a child on a device with a new neurological sign needs urgent imaging and a neurology and haematology review
• A rising pulmonary vascular resistance above the transplant threshold makes a child unsuitable for transplantation, which is why serial catheterisation and timely ventricular assist device unloading matter — irreversible pulmonary hypertension is a contraindication to orthotopic transplantation

Life stages

Care settings

Clinical exam formats

Board mappings

• Cardiac transplantation and ventricular assist devices in children
• Advanced heart failure: indications for mechanical circulatory support and transplantation, device types and complications
• Cardiac transplantation and ventricular assist devices: escalation, INTERMACS profiles, and complications
• Long case: the child with a ventricular assist device awaiting transplantation
• Short case: the transplant survivor on immunosuppression
• Cardiac transplantation and mechanical circulatory support
• Paediatric heart transplantation and ventricular assist devices: indications, devices and complications
• Cardiac: the child on mechanical circulatory support
• Cardiology: heart transplantation and ventricular assist devices
• Patient Care: advanced heart failure, transplantation and mechanical circulatory support
• Medical Expert: heart transplantation and ventricular assist devices in children