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Ventricular Assist Device Program | Overview

Welcome to the Ventricular Assist Device (VAD) Program at the Benderson Family Heart Center at Boston Children’s Hospital. The VAD team — along with the Heart Failure, Cardiomyopathy, and Heart Transplant teams — is leading the way in advanced treatments for children with the most severe forms of heart failure. These teams work closely with you to understand your child’s condition and develop a customized care plan that will best meet their needs and get them feeling healthy again.

New technology has enabled many heart failure patients to thrive with the help of ventricular assist devices, or VADs. VADs are implanted electrical-powered heart pumps that work in concert with the heart to improve blood flow. As one of the busiest surgical centers in the world, Boston Children’s has extensive experience implementing different forms of mechanical circulatory support to improve the health of children. We are a national leader in the use of ventricular assist devices for children with single ventricle defects as well as other complex congenital heart diseases.

Since our program began in 2005, we have implanted VADs in 84 children, with some requiring more than one form of VAD during support.

 

Christina VanderPluym, MD, of Boston Children's Hospital

Why use a VAD?

VADs treat children with severe forms of heart failure for a variety of reasons:

  • Bridge to Decision: A VAD is implanted to support an acutely failing heart. It immediately stabilizes the patient and allows time for the healthcare team to gather all the necessary information to provide the child and family with the best long-term treatment option.
  • Bridge to Recovery: A VAD is placed with the intent of helping the heart and allowing the heart muscle to recover, with the eventual goal being the removal (or explantation) of the VAD once the heart can pump sufficiently on its own.
  • Bridge to Transplant: A VAD is implanted in patients who are waiting for a heart transplant but are becoming more ill because of progressive heart failure. This type of VAD improves a child’s condition and quality of life while they wait for the most suitable donor heart.
  • Destination Therapy or Life-Long Therapy: A VAD is implanted for long-term heart support in children who do not qualify for heart transplantation or who might choose to live on a device instead of being listed for heart transplant.

We have found that overall quality of life for children with end-stage heart failure can improve significantly with a VAD implant. Patients who return home with a VAD can participate in many normal routines and activities.

How do I know if a VAD can help my child?

Children who are diagnosed with advanced heart failure can be referred to our VAD program by their primary care physician, primary cardiologist, or a subspecialist. Our team of expert clinicians will perform a comprehensive evaluation of your child to determine if a VAD is an appropriate option, and if so, which type of VAD is ideal.

The process of deciding whether your child is eligible, about the implanting of the device, and whether your child can eventually go home is often lengthy. It makes many demands on children, families, and caregivers, as does living at home with a VAD. The VAD team at Boston Children’s Hospital strives to build a cooperative working relationship between patients and caregivers so that it feels less like a process and more like a comfortable experience for children.

Leading the way in VAD research and innovation

Benderson Family Heart Center physicians and nurses have played a leading role advancing the research and regulatory issues surrounding pediatric VAD use in the United States. These devices boost blood circulation and can serve as a life-saving bridge to a transplant. Boston Children’s cardiologists were integral in designing and conducting the multi-institutional study of the Berlin Heart®, which gained FDA approval for use in children in 2011. Boston Children’s continues to expand the field of VAD support in children by introducing newer, durable devices such as the Heartmate 3 VAD, which allows children to be discharged home and resume normal activities.

A Boston Children’s patient was the first child in North America to go back to school with a VAD as she waited for a heart transplant. And in the fall of 2014, one of our patients became the first person to attend college while living on campus with a VAD. We were one of the first pediatric centers to successfully bridge a pediatric patient to heart transplant using an Impella 5.5®.

The Heart Center is a member of the Action Learning Network (ACTION), a collaboration of clinicians, researchers, patients, and parents who work to improve cardiac therapies. Many of our physicians, nurse practitioners, and nurses hold leadership positions within ACTION as they advance the field of advanced heart failure therapy.

Recent research publications
  1. Lorts A, Conway J, Schweiger M, Adachi I, Amdani S, Auerbach SR, Barr C, Bleiweis MS, Blume ED, Burstein DS, Cedars A, Chen S, Cousino-Hood MK, Daly KP, Danziger-Isakov LA, Dubyk N, Eastaugh L, Friedland-Little J, Gajarski R, Hasan A, Hawkins B, Jeewa A, Kindel SJ, Kogaki S, Lantz J, Law SP, Maeda K, Mathew J, May LJ, Miera O, Murray J, Niebler RA, O'Connor MJ, Özbaran M, Peng DM, Philip J, Reardon LC, Rosenthal DN, Rossano J, Salazar L, Schumacher KR, Simpson KE, Stiller B, Sutcliffe DL, Tunuguntla H, VanderPluym C, Villa C, Wearden PD, Zafar F, Zimpfer D, Zinn MD, Morales IRD, Cowger J, Buchholz H, Amodeo A. 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. J Heart Lung Transplant. 2021 Aug;40(8):709-732. doi: 10.1016/j.healun.2021.04.015. Epub 2021 May 20. PMID: 34193359
  2. Blume ED., Schweiger M., Eghtesady P., Gelow J., Cedars A., VanderPluym C. VAD in adults with congenital heart disease. ISHLT Adult MCS Guideline. J Heart Lung Transplant 2021 (in press)
  3. Ghbeis M. B., VanderPluym C., Thiagarajan R. R. Hemostatic challenges in pediatric critical care medicine - Hemostatic balance in VAD. Frontiers in Pediatrics. Jan 2021. In press.
  4. Hawkins, B., Fynn-Thompson, F., Daly, K.P., Corf, M., Blume, E., Connor, J.A., Porter, C., Almond, C., VanderPluym, C. (2017). The Evolution of a Pediatric Ventricular Assist Device Program: The Boston Children’s Hospital Experience. Pediatric Cardiology, http://doi.org/10.1007/s00246-017-1615-8.
  5. Hawkins, B., Ventresco, C., VanderPluym, C. (2017). Developing an app for patients on ventricular assist devices: The VADKids app. Progress in Pediatric Cardiology, https://doi.org/10.1016/j.ppedcard.2017.09.004
  6. VanderPluym, C. J., Adachi, I., Niebler, R., Griffiths, E., Fynn-Thompson, F., Chen, S., O'Connor, M. J., Machado, D., Hawkins, B., Bleiweis, M. S., Koehl, D. A., Cantor, R. S., Morales, D., & Lorts, A. 2019. Outcomes of children supported with an intracorporeal continuous-flow left ventricular assist system. J Heart Lung Transplant, 38(4): 385-393.
  7. Villa C., Del Javier Delmo E., Hetzer R., Lorts A., VanderPluym C. LVAD Support in Congenital Heart Disease. ISHLT Monograph series: Mechanical Circulatory Support. Schuler S., Uriel N., Maltais S., Pagani F.2020