Nov. 11, 2009 Texas Children's Hospital is the nation's first pediatric hospital to discharge a child while on an intracorporeal ventricular assist device (VAD), a feat previously accomplished only at adult institutions. The patient, 16-year-old Francisco "Frank" De Santiago, who was implanted with a mechanical heart pump called the HeartMate II on May 19, 2009, was discharged on Oct. 29, 2009.
"This is a promising next step for the care of children with heart failure as Frank is the first patient on record to be medically discharged from a pediatric hospital with a mechanical heart assist device," said Dr. David L.S. Morales, pediatric cardiovascular surgeon at Texas Children's Heart Center, who performed the surgery on De Santiago. "The device, which is implanted into the chest cavity near the heart, stays inside the body rather than outside. It has helped the patient grow stronger by allowing him to eat well, exercise and enjoy life."
Texas Children's Hospital is the first pediatric hospital in the world to use the HeartMate II. Since April, 2008, Morales, Director of the Pediatric Mechanical Circulatory Support Program, has implanted five teen and pre-teen patients, including De Santiago, with VADs -- four of whom have already received successful heart transplants and are enjoying their teen years in good health.
"What's especially significant about De Santiago's case," Morales adds, "is that his life outside the hospital signals a new era of possibilities for pediatric heart failure patients, especially as the number of cases diagnosed annually continues to rise. Until now, pediatric hospitals have kept patients in the hospital, if not the ICU, while awaiting transplant," Morales said..
The Thoratec HeartMate II, about the size of two "D" cell batteries laid end-to-end, received U. S. Food and Drug Administration approval on April 26, 2008. The pump is a long-term, mechanical circulatory support device designed for a broad range of advanced-stage heart failure patients. For these pediatric patients, it allowed them to live until a donor heart becomes available. There is also the possibility that this device may allow some of these children to recover their heart function. Pediatric patients must have a body surface area of at least 1.3 square meters to be a candidate for the device. This is equivalent to an adolescent about 5' 1" tall and weighing about 100 lbs.
De Santiago was flown to Texas Children's Hospital in May after having suffered a temporary stroke. He was diagnosed with dilated cardiomyopathy, a condition in which his heart was enlarged to more than twice a normal size and could not pump blood efficiently. Physicians placed him on a heart transplant list and decided to implant a HeartMate II.
"We feel that Frank is a much better candidate for a heart transplant today than he was five months ago when his heart was failing. The device has improved his heart health and has allowed him to enjoy physical activity during the wait for a donor heart," said Dr. Jeffrey Dreyer, medical director of cardiac transplantation at Texas Children's Hospital.
According to Morales, De Santiago is able to enjoy a more normal life outside the hospital. "He can do many of the things he loves like eating his mother's home cooking, exercising outdoors and going to the movies. He'll be coming to Texas Children's for follow-up visits and physical therapy. We're keeping a close eye on him while he waits for a donor heart," Morales said.
"Both the medical community and parents of children with serious and medically resistant heart failure should know that, using VAD technology, we can provide greater freedom and normalcy for young people awaiting transplants," Morales said. "This improvement in their quality of life and outlook can contribute to their physical health as well, assuming they follow their physician's guidelines for activity and personal care."
Morales noted that the mechanical circulatory support team at Texas Children's Hospital Heart Center uses five different types of VADs in treating pediatric heart patients, the most of any pediatric hospital in the US. He points out that having this variety is important because he knows that TCH can individualize their VAD support for each child, taking their size and cause of heart failure into account.
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