Ventricular Assist Devices at Norton Children’s Heart Institute
Expertise and advanced treatment options available at Norton Children’s Heart Institute provide a bridge for patients awaiting a heart transplant. If a heart transplant is necessary, we have sophisticated ventricular assist devices (VADs) to help keep your child stable until a donor heart is available. VADs are surgically implanted pumps that help support the heart for days or months.
If you think your child may need a consultation, call us. We can get you an appointment quickly.
Who needs a VAD?
Your child will receive a thorough examination from a team that includes Norton Children’s Heart Institute transplant team physicians, pediatric cardiothoracic surgeons, neurologists, an infectious disease specialist, pediatric psychology provider and a Hearts & Hands Care Team member.
Children with the following conditions may require a VAD:
- Chemotherapy-induced heart dysfunction
- Chronic and acute heart transplant rejection
- Congenital heart disease
- Dilated cardiomyopathy
- Duchenne muscular dystrophy cardiomyopathy
- Hypertrophic cardiomyopathy
- Left ventricular noncompaction cardiomyopathy
- Restrictive cardiomyopathy
What kind of VAD will my child get?
Our sophisticated VADs include:
- Aortic balloon pump
- Extracorporeal membrane oxygenation (ECMO) – Provides help with breathing and heart function for days or weeks while the child receives care in the hospital during severe cardiac and/or respiratory dysfunction.
- Impella heart pump – A tiny, state-of-the-art device threaded through an artery into the heart; the device pulls blood from the left ventricle and pushes it into the ascending aorta, mimicking the work of a healthy heart.
- RotaFlow left ventricular assist device or right ventricular assist device – A motor that pulls blood from the circulatory system before it gets to the dysfunctional ventricle and pushes it into the artery following the ventricle, acting as a temporary pump.
- Berlin Heart EXCOR – The first pediatric VAD to get U.S. Food and Drug Administration approval; has been in use since 2011. A type of artificial heart, the Berlin Heart EXCOR takes blood from the left ventricle into a small pump located outside the body and pumps it into the aorta. This relieves the child’s heart by not having to work as hard.
- HeartWare HVAD – An implanted heart pump; the external part of the device is a controller that connects to the pump through a small wire inserted through the abdomen. As a left ventricular assist device, this has a motor that removes blood from the left ventricle and shoots it into the aorta.
How is the VAD placed?
First the patient is evaluated. This process varies from patient to patient. It may take a day or a week. Afterward, a VAD-trained surgical and perfusion team implants the device through an open heart procedure, which includes the attachment of the outflow and inflow tubing to the heart and the aorta, or main artery of the body. The pump is then attached to the tubes and pumps blood to the body.
The patient recovers in the intensive care unit until they are stabilized. The patient is then transitioned to our step-down unit to wait for their transplant or prepare to wait at home.
After the procedure
Our VAD team will train and prepare the patient and caregivers if they will be going home. Children who qualify for discharge from the hospital will be closely followed as an outpatient.
For children discharged from the hospital with a VAD, our educators will help train the child’s family and caregivers, as well as emergency response caregivers in the community, in case of emergency. A VAD team member is available 24 hours a day for questions.
Every patient going home with a VAD needs a team of trained caregivers. He or she must be with a mechanical circulatory support (MCS)-trained provider at all times. This individual usually is a family member and trained while the patient is still in the hospital. Both the patient and caregiver need to be able to perform daily and emergency care of the device.
An MCS educator provides demonstrations, assesses skills and administers written tests to the trained patients and family members. The patient and caregivers must pass written and hands-on skill assessments before going home. They also must pass emergency simulation drills. After this education, the child and caregiver are free to go home and enjoy life away from the hospital.
Norton Children’s Hospital will notify the fire department, emergency medical services (EMS), electric and telephone companies of an MCS patient’s discharge. They will receive a thorough summary of the patient and appropriate training.
Potential complications of a VAD
- Bleeding – All children with a VAD require anticoagulation
- Infection – Every implantable device carries a risk of infection
- Stroke – Despite anticoagulation, stroke is the most frequent severe complication of a VAD
Your child may be added to the following registries:
- International Pediatric Heart Failure Registry
- National Cardiovascular Data Registry ACTION Registry
- Pediatric Heart Transplant Study
- Pediatric Interagency Registry for Mechanical Circulatory Support
Why Norton Children’s Heart Institute for cardiomyopathy, heart failure and heart transplant care?
- Norton Children’s Hospital has been a pioneer in pediatric heart transplant surgery. The hospital was the second site for a successful infant heart transplant in the country and the first in Kentucky, performed in 1986.
- Our program has the oldest living pediatric transplant patients, three individuals who received transplants in 1987.
- Our team includes specialists in cardiomyopathy and neuromuscular disease, among others. Our muscular dystrophy clinics provide a multidisciplinary approach with advanced imaging and more for children with cardiomyopathies.
- Our program has a 100 percent survival rate using ventricular assist devices (VADs) as a bridge to heart transplantation (as of 2018).
- Our heart transplant team includes an infectious disease physician, transplant psychologist, the Hearts & Hands Care Team, and other caregivers to address the physical, intellectual, emotional, social and spiritual needs of patients and their families before and after surgery.
- We offer support systems for children and families waiting for heart transplants, including the Brave Hearts program.
- We have the only pediatric heart genetics program in Kentucky.
- We are approved by the Centers for Medicare & Medicaid Services, and work closely with health insurers to help families.
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