ISHLT consensus statement for the selection and management of pediatric and congenital heart disease patients on ventricular assist devices Endorsed by the American Heart Association

Abstract

Heart failure (HF) is a significant cause of mortality in children and therefore there is interest in understanding the optimal way to support these children with Ventricular Assist Devices (VAD) to improve outcomes. VAD therapy is now regarded as an important treatment option in pediatric HF. The 2019 International Society for Heart and Lung Transplantation (ISHLT) registry report shows that there is an increasing trend towards using VADs as a bridge to transplant (BTT) with currently over one-third of patients transplanted being bridged with a VAD.1
The immediate aim of VAD therapy is to provide hemodynamic stability for a failing circulation unresponsive to medical therapy. The VAD should be implanted before the development of severe end-organ dysfunction in order to optimize clinical outcomes. The goal is to improve tissue and organ perfusion, improve quality of life (QoL) and improve waitlist survival. Importantly, VAD therapy may not only lead to patient stability but may also afford the opportunity for patient rehabilitation prior to heart transplantation (HT).
Despite the increase in VAD use within pediatrics over the last decade, the majority of centers implant less than 10 VADs in children per year.2
Thus, local data is limited for analysis of outcomes and therefore multi-center collaboration and consensus is essential in understanding this complex and dynamic field.
ISHLT has recognized the importance of a consensus statement on the selection and management of pediatric and congenital heart disease (CHD) patients undergoing VAD implantation. The purpose of this document is to provide expert-consensus derived recommendations and whenever possible, these recommendations shall be guided by evidence. The creation of this consensus document required multiples steps including the engagement of the ISHLT councils, identification and selection of experts in the field, and the development of 13 Tasks Forces. Extensive literature searches were performed but due to the lack of comparative trials in pediatrics, this document was written as a literature review with expert opinion rather than based on level of evidence.