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Clinical pharmacology considerations for children supported with ventricular assist devices

Published online by Cambridge University Press:  11 July 2018

Jennifer Sherwin ,
Elizabeth Thompson ,
Kevin D. Hill ,
Kevin Watt ,
Andrew J. Lodge ,
Daniel Gonzalez  and
Christoph P. Hornik
Jennifer Sherwin
Affiliation:
From the Department of Pediatrics, Duke University Hospital, Durham, NC, USA
Elizabeth Thompson
Affiliation:
From the Department of Pediatrics, Duke University Hospital, Durham, NC, USA
Kevin D. Hill
Affiliation:
From the Department of Pediatrics, Duke University Hospital, Durham, NC, USA Duke Clinical Research Institute, Duke University, Durham, NC, USA
Kevin Watt
Affiliation:
From the Department of Pediatrics, Duke University Hospital, Durham, NC, USA Duke Clinical Research Institute, Duke University, Durham, NC, USA
Andrew J. Lodge
Affiliation:
Department of Surgery, Duke University Hospital, Durham, NC, USA
Daniel Gonzalez
Affiliation:
Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Christoph P. Hornik*
Affiliation:
From the Department of Pediatrics, Duke University Hospital, Durham, NC, USA Duke Clinical Research Institute, Duke University, Durham, NC, USA
*
Author for correspondence: C. P. Hornik, MD, MPH, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA. Tel: +919 668 8935; Fax: +919 668 7032; E-mail: christoph.hornik@duke.edu
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Abstract

The ventricular assist device is being increasingly used as a “bridge-to-transplant” option in children with heart failure who have failed medical management. Care for this medically complex population must be optimised, including through concomitant pharmacotherapy. Pharmacokinetic/pharmacodynamic alterations affecting pharmacotherapy are increasingly discovered in children supported with extracorporeal membrane oxygenation, another form of mechanical circulatory support. Similarities between extracorporeal membrane oxygenation and ventricular assist devices support the hypothesis that similar alterations may exist in ventricular assist device-supported patients. We conducted a literature review to assess the current data available on pharmacokinetics/pharmacodynamics in children with ventricular assist devices. We found two adult and no paediatric pharmacokinetic/pharmacodynamic studies in ventricular assist device-supported patients. While mechanisms may be partially extrapolated from children supported with extracorporeal membrane oxygenation, dedicated investigation of the paediatric ventricular assist device population is crucial given the inherent differences between the two forms of mechanical circulatory support, and pathophysiology that is unique to these patients. Commonly used drugs such as anticoagulants and antibiotics have narrow therapeutic windows with devastating consequences if under-dosed or over-dosed. Clinical studies are urgently needed to improve outcomes and maximise the potential of ventricular assist devices in this vulnerable population.

Keywords

Ventricular assist deviceclinical pharmacologychildrenpharmacokineticspharmacodynamics
Type
Review Article
Information
Cardiology in the Young , Volume 28 , Issue 9 , September 2018 , pp. 1082 - 1090
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Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Sherwin J, Thompson E, Hill KD, Watt K, Lodge AJ, Gonzalez D, Hornik CP. (2018) Clinical Pharmacology Considerations for Children Supported with Ventricular Assist Devices. Cardiology in the Young28: 1082–1090. doi: 10.1017/S1047951118001075

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