Ventricular Assist Devices (VADs) are small pumps that take over the work of the heart in pumping the blood through the body. Patients who need a heart transplant, but for whom there is no donor heart available, might be given a VAD for what’s called a bridge-to-transplant while they wait for a donor.
PediMag, the pediatric version of the adult device, CentriMag, is an external device designed for short-term use in infants with heart failure. PediMag can also be used to support children after heart transplant surgery if they experience organ rejection and need time for their hearts to rest and heal, according to Jonathan M. Chen, MD, Surgical Director of Pediatric Heart Transplantation at Morgan Stanley Children’s Hospital of New York. Dr. Chen has extensive experience treating children with heart failure and has recently authored an account of his first successful use of the PediMag as a biventricular bridge-to-transplant in an infant.
The PediMag ventricular assist device is slightly smaller than a BlackBerry phone.
Dr. Chen says that although PediMag has been available in Europe for a number of years, it is only now gaining wider use in the U.S. — although in his view this device is clearly safer than other VADS available in the U.S. “Certain other VADs have the advantage that children can go home while using the device. Yet those pumps pose a serious risk of blood clots and stroke,” Dr. Chen explains. Although risk of stroke can be as high as 35% with other devices, “PediMag has a much lower rate of complications related to clot.” Unlike the older mechanical pumps, PediMag and CentriMag use a magnetically levitated, bearingless technology.
In addition to supporting the heart, PediMag can easily be modified so as to provide extracorporeal membrane oxygenation, or ECMO, in cases where a child’s lungs also need support. This flexibility is highly valuable to surgeons like Dr. Chen, whose patients may have both heart and lung failure. Moreover, not only can PediMag be connected to an ECMO circuit, but it can be done very simply and quickly.
This ease of use is a major advance that benefits young patients, according to Dr. Chen. Historically, devices that did the job of PediMag and CentriMag were hulking machines with a vast array of controls, and they were complicated enough that their use was frequently curtailed by lack of expertise. PediMag is far more streamlined, so that once a patient is hooked up, “Practically any doctor or nurse should be capable of handling it,” says Dr. Chen.
*This blog post was originally published at Columbia University Department of Surgery Blog*