A single-center experience with recovery of heart function in children following ventricular assist device support.

Abstract

Objective: Ventricular assist device (VAD) implantation is an established treatment for infants with severe heart failure (HF), serving as a bridge to heart transplantation or enabling myocardial recovery. This study aims to evaluate the probability of ventricular recovery following VAD support in infants with severe HF secondary to myocarditis. In addition, we analyze clinical experiences focusing on the weaning process, challenges during explantation, and outcomes, with special attention to a small cohort (n = 4) to highlight specific findings.

Patients and methods: From 1988 to 2024, 63 consecutive pediatric HF patients were supported with VAD systems. This retrospective descriptive study includes four patients (2016-2024) who achieved myocardial recovery and underwent VAD explantation. Weaning assessments included heart catheterization and echocardiography to determine suitability for VAD removal. One patient with congenital heart disease and severe HF was excluded due to prior reporting.

Results: Four patients diagnosed with cardiomyopathy - three with parvovirus B19 confirmed by polymerase chain reaction and one with arrhythmogenic cardiomyopathy - received Berlin Heart^® Excor left VADs. Two children developed frequent valve thrombosis requiring pump replacement. All patients experienced mild-to-moderate neurological complications postimplantation. Renal and hepatic functions normalized by follow-up.

Conclusions: Myocardial recovery during VAD support is possible, particularly in children with severe myocarditis and cardiomyopathy. Concurrent HF medications alongside VAD support appear to promote recovery. Furthermore, VAD therapy improves systemic hemodynamics, contributing to normalization of renal and hepatic functions. These findings support the use of VADs for recovery in selected pediatric patients.