Page 7 - VAD Guidelines

Pediatric Ventricular Assist Device (VAD) Guidelines

Critical to the successful deployment of VAD support is the process of timely and thoughtful evaluation.
For each patient suffering from end-stage heart failure there is an ideal time for the use of VAD in the
setting of unique size and anatomical constraints that pediatric patients often pose. Emergency use of
ECMO or Impella can provide cardiovascular stability and allow a better evaluation of the options to be
made.
Algorithm for Mechanical Support in Acute Heart Failure

Pre-Implant Evaluation

Many of the tests and investigations prior to initiating mechanical support are part of routine heart
failure and CVIVU management. More specialist testing is required prior to initiating VAD provided time
permits. A comprehensive list of investigations is available in Appendix 1. Pre VAD labs should also
include LDH, HLA Ab screen and genetic testing (if appropriate). Likewise additional consults to
important services for the management of these children are also necessary. A VAD implant requires
medical, psychosocial and financial discussion if possible prior to a decision.
Consults:
CT Surgery Financial Palliative Care
Infectious Disease Dental Evaluation Social Work
Nutrition Child Life Psychology
Pharmacy (Anticoagulation) Chaplain
If clinically indicated: Hematology, Neurology/Neuromuscular, Nephrology

Updated 3/24/2019 page 7