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Canadian Journal of Cardiology

Mechanical Circulatory Support in Pediatric and Adult Congenital Heart Disease

Published:October 14, 2019DOI:https://doi.org/10.1016/j.cjca.2019.10.006

      Abstract

      The use of ventricular-assist device (VAD) support continues to increase and it is now considered part of the standard of care for most adult and children with end-stage heart failure unresponsive to medical management. However, the application of VAD therapy in both the pediatric and adult population with congenital heart disease (CHD) has been less extensive and continues to face significant challenges. Nevertheless, the experience is growing and the use of VADs in the CHD population is no longer limited to case reports, thereby increasing our understanding of how best to support this diverse patient population. The current body of literature provides a framework to understand the outcomes of this unique patient population with respect to mortality, risk factors, and associated morbidities in both adult and pediatric patients with CHD. This review will summarize that body of literature with focus on outcomes based on device type and anatomy. We also highlight efforts made by the community to improve outcomes of patients with CHD on VAD support.

      Résumé

      Les dispositifs d’assistance ventriculaire (DAV) sont de plus en plus utilisés, et ils font désormais partie de la norme de soins dans la plupart des cas d’insuffisance cardiaque terminale réfractaire à la prise en charge médicale chez les adultes et les enfants. Le recours aux DAV chez les enfants et les adultes atteints de cardiopathie congénitale est toutefois moins répandu et continue de poser des défis de taille. Cela dit, nous acquérons graduellement de l’expérience, et le recours aux DAV auprès des patients atteints de cardiopathie congénitale n’est plus limité aux rapports de cas, ce qui nous permet de mieux comprendre comment bien soutenir cette population diversifiée de patients. L’ensemble des études publiées à ce jour fournit un cadre pour comprendre les résultats observés dans cette population de patients unique sur les plans de la mortalité, des facteurs de risque et des affections concomitantes, tant chez les adultes que chez les enfants atteints de cardiopathie congénitale. Nous résumons ici les constatations issues des études publiées, en tenant compte notamment du type de dispositif et des caractéristiques anatomiques. Nous présentons aussi les initiatives mises en œuvre par la collectivité pour améliorer les résultats des patients atteints de cardiopathie congénitale porteurs d’un DAV.
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