Pediatric Cardiology and Cardiac Surgery
Vol.27 No.3 2011 (111-117)
Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, Japan
Extracorporeal Membrane Oxygenation (ECMO) is a standard mechanical circulatory support in a pediatric patient with advanced heart failure. Difficulty in long-term support by ECMO prompted the introduction of a ventricular assist device (VAD) dedicated for children in Europe and the USA. Although adult-size VADs were used for this purpose in Japan due to the lack of availability of a pediatric VAD, this was not the case for small children less than 20 kg. Berlin Heart Excor, which comes in a variety of sizes, has been widely implanted in more than 800 pediatric patients with an estimated one-year survival of 70%. A revised organ transplantation law enabled us to perform pediatric heart transplantation in Japan. It is expected, however, that waiting period will be long and any VAD support will be mandatory to reach transplantation safely. In order to cope with this difficult situation, a clinical trial of Excor that is led by surgeons’ group was initiated in December 2010 in Japan. Several pediatric implantable VADs are under development in Japan, as well as in the USA and Europe. The expeditious application of these devices is needed to allow children with advanced heart failure to be discharged home.