Andersons pediatric cardiology 1765
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institutionalapproach.HomeINRmachinesmaybeusefulforfamiliesandare
insomecasescoveredbyinsurance,typicallyafteraspecificperiodoftimeon
anticoagulationtherapyhasbeenmet.
Patientsdischargedtohomemayrequireongoingphysicalandoccupational
therapies,whichasnotedpreviouslyarequitebeneficialtorehabilitationpriorto
transplant.120Transitiontoaprescribedexerciseprogramshouldbeconsidered
forongoingrehabilitation.Patientsmayalsoelecttoreturntomorevigorous
activitiesastheirphysicalconditioningimproves,whichisreasonablewithin
limitsofmaintainingdevicesafetyandbarringanyimposedrestrictions
secondarytoanticoagulation.Integrationintotheschooland/ordaycaresettings
hasbeenachievedandshowntobeafeasibleoption.BecausethepediatricVAD
patientisexpectedtobeinthecareofsomeonetrainedtorespondappropriately
tothedeviceandpatient,additionaloff-siteteachingmaybenecessarywith
reintegrationintothecommunity.121
Educationalcompetenciesshouldbereassessedintheoutpatientsetting
(device,drivelinedressingchanges)onaregularbasis.Patientsareoften
accompaniedbyprimarycaregiversandthosewhodonotroutinelyattendvisits,
butcareforthepatientshouldalsobeconsideredforperiodicreeducation.Early
referralforpsychosocialsupportsandinterventionshouldbeconsideredfor
caregiversandpediatricVADpatients.AlthoughVADsareafeasiblemeansof
supportingpatientswithend-stageheartfailureuntilthetimeoftransplantation,
thereisapotentialforsignificantpsychosocialimpactonbothpatientsand
caregivers.122–124
Conclusion
Long-termMCSforend-stageheartfailurehasbecomestandardtherapyatmost
pediatrichearttransplantcenters,withexcellentoutcomesinmostpatients.
However,morepediatric-specificdevicesareneededandtherecontinuestobe
challengeswithcertainpopulations,includingsmallinfantsandpatientswith
complexCHD.Manychildrenaresupportedwithadultdevicesandtheuseof
thesedeviceshaveusheredintheeraofoutpatientmanagementforchildrenon
VADs.TherehavebeentremendousadvancementsinMCSforchildrenoverthe
pastdecade,andcomingyearsholdgreatpromiseforfurtheradvancements.
AnnotatedReferences
BlumeED,VanderPluymC,LortsA,etal.Second
annualpediatricinteragencyregistryfor
mechanicalcirculatorysupport(Pedimacs)
report:Pre-implantcharacteristicsandoutcomes.
JHeartLungTransplant.2018;37(1):38–45.
Thisstudyisthemostrecentannualreportfrom
Pedimacs.Thismulticenterregistryofpediatric
VADsdemonstratedthecurrentstateofMCS
andchildrenandallowsforin-depthanalyses
thatwouldnotbepossiblefromsinglecenter
studies.
FraserCDJr,JaquissRDB,RosenthalDN,etal.
Prospectivetrialofapediatricventricularassist
device.NEnglJMed.2012;367(6):532–541.
Thisisaseminalstudyinthefieldofpediatric
MCSasitrepresentsthefirstprospectivestudy
ofadurableVADinchildren.TheBerlinHeart
ExcorVADwascomparedagainstahistorical
controlgroupofpatientsthatweresupportedon
ECMO.Therewasasignificantimprovementin
survivalnotedinthechildrenthatreceivedthe
BerlinHeartExcorVAD.
MoralesDLS,ZafarF,AlmondCS,etal.Berlin
HeartEXCORuseinpatientswithcongenital
