Discharged VAD implanted pediatric patient receives successful heart transplant after eight months

Heart-assist device helped ready 16-year-old for successful surgery

The wait is over for 16-year-old Francesco "Frank" De Santiago. On January 29, De Santiago received a donor heart in a nine-hour transplant operation at Texas Children's Heart Center De Santiago made news last October as the first child ever discharged from a pediatric hospital with an implanted mechanical heart pump, or ventricular assist device (VAD). Until then, pediatric patients with VADs remained in the hospital, often in ICU, while awaiting a donor heart.

"Frank's surgery went extremely well; he was a much better candidate for a heart transplant now than eight months ago when his heart was failing," said Dr. David L.D. Morales, pediatric cardiovascular surgeon at Texas Children's Heart Center who implanted Frank's device last May and performed his recent heart transplant. "The device improved his physical health and allowed him be discharged so he could enjoy some normal teen activity during the wait for a donor heart. Texas Children's is leading the way in using five different types of VAD technology to help pediatric patients enhance their quality of life and outlook so they are better prepared for their transplant surgery."

De Santiago will continue to reside in Houston and undergo rehabilitation and follow-up check-ups for three months before returning to his home in south Texas. He calls his heart "a gift" and is learning how to care for himself and his new organ.

Morales said about 450 pediatric heart transplants occur annually in the United State; yet the number of pediatric heart failure cases diagnosed annually continues to rise. He believes that the future of pediatric heart care resides in VAD technology and Texas Children's Heart Center uses the most of any pediatric hospital in the country.

"Heart failure in children is now being diagnosed at an increased rate," said Dr. Jeffrey Dreyer, medical director of cardiac transplantation at Texas Children's Hospital. "Advances in VAD technology provide new opportunities for treatment and recovery. Prior to VADs, a significant number of pediatric heart failure patients did not survive long enough to receive a heart transplant. We are fortunate to have this technology and expertise at Texas Children's."

Frank De Santiago was transferred to Texas Children's Hospital from south Texas after experiencing 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. The Texas Children's Heart Center physician team placed him on the heart transplant list and concluded he was an excellent candidate for the HeartMate II VAD that could keep him alive until a suitable donor heart became available.

Texas Children's Hospital is the first pediatric hospital in the world to use the HeartMate II in pediatric patients with a body surface area of at least 1.3 square meters. The device, about the size of two "D" cell batteries laid end-to-end, received U. S. Food and Drug Administration approval on April 26, 2008. Since then, Morales, also director of the Pediatric Mechanical Circulatory Support Program, has implanted the HeartMate II in five teen or pre-teen patients. All patients experienced improved heart health on the device, which allowed them to live until donor hearts became available.

Source: Texas Children's Hospital