Surgical Innovations
Surgeons Devise a Creative Solution to Sustain Children with Heart Failure
Leon Sarpong, age 7, was on the CentriMag ® device for four days.
He received a heart transplant and is doing very well today, says his surgeon, Jonathan M. Chen, MD (left). Within the walls of the pediatric heart transplant program at NewYork-Presbyterian/ Columbia, incredible things are happening.
Just this year, surgeons devised a way to adapt the CentriMag®, an adult heart pump, so that they could implant smaller versions in four young children with acute heart failure.
The tiny devices were used to keep these children, ages 3-10 years, healthy until they were able to receive a heart transplant.
Three of the four were able to receive successful transplants.
"The kids have done very well with their devices," says Jonathan M. Chen, MD.
Dr. Chen led the team that adapted the biventricular device and performed the procedures.
Approved for use in adults, it regulates blood flow through both left and right ventricles of patients with acute heart failure. Unlike other biventricular devices with moving inner parts that wear down over time, CentriMag is powered by a levitating magnet.
It is believed that the absence of moving parts will extend its life considerably compared to other devices.
There is no such pump designed specifically for children, however.
If a child suffers acute heart failure before the age of one, doctors can use extracorporeal membrane oxygenation, or ECMO, to provide temporary heart and lung support until transplantation.
Those older than age ten can usually be given an adult pump until a heart transplant is possible.
But for children between the ages of one and ten, until now there has been no acceptable way to stabilize them and offer a bridge to transplantation, according to Dr. Chen. ECMO has been an option, but a very undesirable one because of its high risks and dangerous side effects in children within this age bracket.
"Without the support of a heart pump, children between one and ten with heart failure can have as high as a 20% risk of dying while waiting for a transplant, so the ability to adapt the CentriMag device will make a major impact in their lives."
In order to use the CentriMag device in such young children, Dr. Chen changed the size of the cannulae, or the flexible tubes connecting the device into the blood vessels.
He also altered the pump's speed so that it would spin more slowly than it does when placed in adult patients (because it pumps a lower volume of blood in children than in adults).
After implantation with the pump, children are able to resume many of their activities (unlike ECMO, where they must be sedated and paralyzed on a ventilator).
Most importantly, the implanted device allows children to stay active and even eat normally, making them far stronger, healthier candidates for transplantation when the time comes.
The CentriMag solution is just one example of the kind of innovation that sets Columbia's pediatric heart transplant program apart.
Recognized as one of the top three pediatric heart transplant programs in the nation, Columbia's faculty have been at the forefront of the management of congenital heart failure, the development of left ventricular assist devices, and the advancement of transplant surgery in children.
"While it is important to have a great cardiologist and surgeon, the success of heart transplant patients depends heavily on the care provided by pediatric nurses, cardiologists, anesthesiologists, and intensivists."
According to Dr. Chen, where patients really benefit is from the expertise of the institution as a whole.
"Extreme subspecialists make a critical difference in the success of treating patients with end-stage organ failure.
For example, we have experts who specialize in pediatric transplant nutrition, transplant psychiatry, and other very focused areas.
A regular nutritionist would not typically know it, but nutritionists who specialize in transplant nutrition know that certain drugs given after transplantation interact with particular foods or medications, for instance.
Such experience affects treatment decisions on a daily basis and clearly improves the quality of care for transplant patients."
In order to facilitate optimum care, the Morgan Stanley Children's Hospital of NewYork-Presbyterian/Columbia has united all pediatric transplantation services (heart, lung, heart-lung, abdominal, kidney, and liver) in one location.
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