Expertise and advanced treatment options available at Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, 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 the 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 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 medicine
- 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 Choose Norton Children’s Heart Institute
- Norton Children’s Hospital has been a pioneer in pediatric cardiothoracic surgery, performing Kentucky’s first pediatric heart transplant in 1986 and becoming the second site in the United States to perform an infant heart transplant.
- The American Board of Thoracic Surgery has certified our cardiothoracic surgeons in congenital heart surgery.
- The Adult Congenital Heart Association has accredited Norton Children’s Heart Institute’s Adult Congenital Heart Program as the only comprehensive care center in Kentucky and Indiana treating adults born with a heart defect.
- More than 5,000 children a year visit Norton Children’s Heart Institute for advanced heart care.
- Norton Children’s Heart Institute has offices across Kentucky and Southern Indiana to bring quality pediatric heart care closer to home.
- The Jennifer Lawrence Cardiac Intensive Care Unit (CICU) at Norton Children’s Hospital is the largest dedicated CICU in Kentucky, equipped with 17 private rooms and the newest technology available for heart care.