Paeds Vivas · cardiology
Cardiac transplantation and ventricular assist devices — branching viva
Branching viva from the definition of transplantation and ventricular assist devices through the three-axis classification, the INTERMACS urgency profiles, the Berlin Heart EXCOR evidence, the denervated transplanted heart, and the complications that dominate each stage.
On this page
Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in a tertiary cardiac centre. The consultant asks you to talk through four children: a four-month-old with a refractory dilated cardiomyopathy being assessed for a device, a two-year-old who has collapsed in critical cardiogenic shock, a ten-year-old on a Berlin Heart EXCOR who develops a new neurological sign, and a sixteen-year-old transplant recipient attending for long-term follow-up.
Station opening
Examiner: "Define cardiac transplantation and ventricular assist devices, and explain when they enter a child's care." [4]
Strong candidate (must-hit)
- Defines transplantation as the definitive replacement of the failing heart with a donor organ, and a ventricular assist device as a mechanical pump that unloads and supports the failing ventricle; explains that they are the two destinations for the child whose heart failure has become refractory to medical therapy — a VAD used as a bridge to transplantation (most), a bridge to recovery (myocarditis and selected cardiomyopathy), a bridge to candidacy, or rarely destination therapy; and frames the whole pathway as a race to transplant before irreversible end-organ or pulmonary vascular injury. [4]
Weak candidate
- "A VAD is a pump we put in when the heart fails, and transplant is when we give a new heart." [4]
References5ShowHide
- [1]Almond CS; Morales DL; Blackstone EH; et al Berlin Heart EXCOR pediatric ventricular assist device for bridge to heart transplantation in US children. Circulation, 2013.PMID 23538380
- [3]Blume ED; VanderPluym C; Lorts A; et al Second annual Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) report: Pre-implant characteristics and outcomes. J Heart Lung Transplant, 2018.PMID 28965736
- [4]D'Addese L; Boyle G; Spencer R; Gauvreau K; Fynn-Thompson F; Blume E Pediatric heart transplantation in the current era. Curr Opin Pediatr, 2019.PMID 31335745
- [8]Singh TP; Cherikh WS; Chambers DC; et al The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Twenty-fourth pediatric heart transplantation report - 2021; focus on recipient characteristics. J Heart Lung Transplant, 2021.PMID 34420853
- [10]Niebler RA; Ghanayem N; VanderPluym C; et al Stroke in pediatric ventricular assist device patients-a pedimacs registry analysis. J Heart Lung Transplant, 2021.PMID 33824064