Ventricular assist device sustains patient's life while awaiting heart transplant

Clinical expertise in Cardiac Care at Children's has led to the first ventricular assist device surgery ever performed at the hospital. Dr. Joseph Forbess, director, Division of Pediatric Cardiothoracic Surgery, Children's Medical Center Dallas, Dr. Kristine Guleserian, a cardiothoracic surgeon on the medical staff at Children's, and Dr. Dan Meyer, Sarah M. and Charles E. Seay Distinguished Chair in Thoracic Surgery at UT Southwestern, surgically implanted a Thoratec left ventricular assist device in 15-year-old patient Michael Gonzalez on Feb. 23.

A ventricular assist device is designed to assume function for either or both of the heart's ventricles, the portion of the heart responsible for pumping blood through the lungs and out to the body.

"Due to irrecoverable heart failure, kidney failure and an expected long wait for a combined heart-kidney transplant, the VAD was the most appropriate therapy for Michael," Dr. Guleserian said. "The device is considered a bridge to transplantation, because it helps sustain a patient's life while awaiting a donor."

Many adult patients with VADs are able to leave the hospital once they are hemodynamically stable and their anticoagulation (blood thinners) and other issues are stable, so they can resume a relatively normal daily life and do the "waiting" in the comfort of their own home. Since Michael requires a combined transplant, he will transition to the regular eighth floor cardiovascular unit to await a suitable donor after spending several weeks in the Cardiac ICU at Children's following his VAD surgery.

VADs have continued to increase in sophistication and efficiency while decreasing in size and risk since their first introduction in the late 1970's. The most common VADs used in the United States are implanted in adults during open-heart surgery, but the surgery is becoming more common in the pediatric population.

"I expect that we will be performing more VAD implantations in the future as our heart failure population continues to increase and there is increased familiarity with these devices," Dr. Forbess said.