Mechanical circulatory support for both acute and chronic heart failure is a widely applied therapeutic option in the adult population with a variety of devices clinically available. Technology in this field has advanced sufficiently such that long-term support or "destination therapy" has become a generally accepted reality. Similar progress has not occurred in the field of device support for heart failure in children. While the number of potential patients is significantly lower in the pediatric population, the clinical relevance and poignancy of individual need are nonetheless real. Until recently, children with heart failure have been largely disadvantaged in comparison to their adult counterparts. The DeBakey VAD Child (MicroMed Technology, Inc, Houston, TX) represents a hopeful initial step in the direction of reducing the technological gap between adults and children. While the clinical experience with this device is limited at present, preliminary results are encouraging. This report will provide an overview of the DeBakey VAD Child, including device specifications, indications for clinical use, surgical and postoperative considerations, and updated clinical experience.
"Its use in children has been limited to date. A recent report by Fraser et al.  summarized a single center experience of 6 patients with the DeBakey VAD Child. The average age of the patients was 11 years (range, 6 to 15 years) with a BSA of 0.8 to 1.7 m2. "
[Show abstract][Hide abstract] ABSTRACT: The majority of children awaiting heart transplantation require inotropic support, mechanical ventilation, and/or extracorporeal membrane oxygenation (ECMO) support. Unfortunately, due to the limited pool of organs, many of these children do not survive to transplant. Mechanical circulatory support of the failing heart in pediatrics is a new and rapidly developing field world-wide. It is utilized in children with acute congestive heart failure associated with congenital heart disease, cardiomyopathy, and myocarditis, both as a bridge to transplantation and as a bridge to myocardial recovery. The current arsenal of mechanical assist devices available for children is limited to ECMO, intra-aortic balloon counterpulsation, centrifugal pump ventricular assist devices, the DeBakey ventricular assist device Child; the Thoratec ventricular assist device; and the Berlin Heart. In the spring of 2004, five contracts were awarded by the National Heart, Lung and Blood Institute to support preclinical development for a range of pediatric ventricular assist devices and similar circulatory support systems. The support of early development efforts provided by this program is expected to yield several devices that will be ready for clinical trials within the next few years. Our work reviews the current international experience with mechanical circulatory support in children and summarizes our own experience since 2005 with the Berlin Heart, comparing the indications for use, length of support, and outcome between these modalities.
Current Cardiology Reviews 02/2010; 6(1):46-53. DOI:10.2174/157340310790231617
[Show abstract][Hide abstract] ABSTRACT: Designing dividing wall columns (DWC) – energy-efficient separators of ternary mixtures – involves multivariable problem solving. These variables interact with each other and need to be optimized simultaneously to obtain the best design. In this work, a practical method employing response surface methodology (RSM) is proposed for DWC design and optimization. The optimum DWC structure can be found in a practical manner while minimizing simulation runs. The proposed method was tested in the design and optimization of an acetic acid purification process. The RSM based optimization effectively copes with interactions between optimizing variables and its predictions agreed well with the results of rigorous simulation. The DWC system designed by the proposed method decreased total annual costs by 44.57% compared with conventional distillation.
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