Though pediatric VAD use is increasing, data around outcomes related to patient treatment and device selection decisions is not yet robust enough to inform consistent practices among providers. The authors of “Patient and Device Selection in Pediatric MCS: A Review of Current Consensus and Unsettled Questions” note that this is particularly true of patients in groups with higher risk factors and where there are more complex factors involved in the risk/benefit analysis and identify the least consistency among practitioners in cases of patients with single ventricle physiology, cardiogenic shock, and hypertrophic or restrictive cardiomyopathy. Surveys of ACTION learning network members provide insight into current-state decision making among VAD providers, including cardiologists, cardiothoracic surgeons and VAD coordinators, about when, with whom, and how they implement VADs in varying patient scenarios. To summarize these findings, the authors created a harmonization document highlighting recommended laboratory studies, imaging studies, and important multidisciplinary consultations. Their recommendations include echocardiogram, EKG and BNP as part of cardiac assessment; increased patient and family education to support shared decision-making; a standardized multidisciplinary review of patient pre-VAD evaluation for more collaborative, comprehensive discussions around key questions such as timing and device selection; and an effort to move toward institutional policies that enable more consistent approaches to decision making by outlining thresholds for implantation and device.
This ACTION study was published March 24, 2022 in Pediatric Cardiology. Congratulations to the authors:
- Joshua M. Friedland‑Little
- Anna Joong
- Svetlana B. Shugh
- Matthew J. O’Connor
- Neha Bansal
- Ryan R. Davies
- Michelle S. Plouz
CITATION
Friedland-Little, J.M., Joong, A., Shugh, S.B. et al. Patient and Device Selection in Pediatric MCS: A Review of Current Consensus and Unsettled Questions. Pediatr Cardiol(2022). https://doi.org/10.1007/s00246-022-02880-6
