VADs Save Lives, Improve Outcomes

By Jeff Ballinger

Pediatric heart surgeons at Columbia are renowned for successfully transplanting hearts into children with complex heart conditions, particularly in cases turned down by other institutions and programs in the United States and around the world.

Over the past 10 to 15 years, an increasing number of these young patients—because of the complexity and severity of their conditions—have needed the help of a ventricular assist device (VAD) to pump blood through the rest of the body while waiting for a suitable heart.

“Even in the last 10 years, it has been an amazing time to witness the growth in these devices and to be a part of their realization for children,” says Sabrina Pia Law, MD, associate professor of pediatrics and director of the pediatric VAD program at NewYork-Presbyterian Morgan Stanley Children’s Hospital.

When Dr. Law first joined Columbia eight years ago, the program was implanting about five VADs a year. Columbia now implants about 30 to 35 devices each year, while most centers implant 10 or fewer annually.

The increase in use of VADs is mostly attributable to medical advances, not the number of children with heart issues or a decline in the number of donor hearts.

“We’re keeping more children alive than before with advances in congenital cardiac surgery,” says Dr. Law. Some of these surgical procedures fail as the child gets older, and patients turn to VAD technology, which is increasingly available to more patients.

At Columbia, nearly 50% of patients waiting for a transplant receive a VAD, compared with the national average of 20% to 25%. Many of Columbia’s patients have been rejected for treatment by other hospitals due to the complexity of their conditions, Dr. Law says. “We pride ourselves in caring for very, very complex patients.”

As it pushes the boundaries of treatments in numerous trials, Columbia’s program has become one of the global leaders with newer miniaturized devices and technological refinements that have widened the options available to children and even infants.

Columbia physicians and NewYork-Presbyterian Morgan Stanley Children’s Hospital are participating in the PumpKIN (Pumps for Kids, Infants, and Neonates) trial, a seven-center feasibility study of the investigational Infant Jarvik 2015 VAD in children with heart failure who require mechanical circulatory support.

The Jarvik 2015 was specifically designed for small children weighing between 8 and 30 kilograms and is completely implantable. The trial is evaluating the device as a bridge to transplant and to recovery.

“If successful, this will provide clinicians with an alternative to current VADs that are effective but can only be used as a bridge to transplant because they are not fully implantable, so children must stay in the hospital under close supervision,” Dr. Law says.

The Jarvik VAD would allow a patient to go home and live a more normal life, potentially speeding up the child’s physical and overall development. “As a child waits for transplant, one of the most important objectives is to get them as healthy and as strong as possible before they go into the OR for their transplant,” Dr. Law says.

More information is available by calling (212) 305-6575.