Ventricular Assist Device (VAD)

The Heart Institute at UPMC Children's Hospital of Pittsburgh has long been a national leader in the use of lifesaving ventricular assist devices (VADs) for children in heart failure. For children in heart failure, the ventricular assist device, or VAD, can be a lifesaver. The VAD is a specialized pump capable of maintaining blood flow to the body, which allows the heart to rest. The VAD can serve as a “bridge” to keep patients alive until a donor heart becomes available for transplant. A growing body of evidence has shown that VADs can also be a bridge to recovery, enabling the heart to heal without a transplant.

Until recently, however, VADs were approved by the FDA only for use in adults and larger adolescents in the United States, but none was designed and approved for use in infants and toddlers. Heart-lung machines and ECMO can keep a child alive for a short time prior to transplant, but when a donor heart is not readily available, and a child needs to be supported for weeks or months, these efforts often are not enough.

Prior to FDA approval, Children’s surgeons were able to use an FDC humanitarian device exemption to implant experimental VADs as bridges to transplant for some select pediatric patients. Surprisingly, almost one-third of the children implanted with VADs ended up not needing the transplant after their hearts were given a chance to heal. As these children were successfully weaned off their VADs, doctors at the Heart Institute became among the first in the country to use VADs as bridges to recovery, essentially making transplants unnecessary for some patients.

One VAD that has shown promise at Children’s is the recently FDA approved Berlin Heart EXCOR® Pediatric, an external pulsatile, pneumatically driven VAD that can be used to support one or both ventricles. Children’s was one of the trial centers for this device and has implanted the Berlin Heart as a mechanical cardiac support system for critically ill pediatric patients suffering from severe heart failure. Unlike standard heart-lung machines, the Berlin Heart Pediatric EXCOR has been used as a short-term, mid-term, and long-term support system, assisting failing hearts for several days up to several months. Unlike other VADs, EXCOR Pediatric can be used to support children of all age groups, from newborns to teenagers. 

To make a referral for mechanical circulatory support for cardiovascular failure, please call 412-692-5540.