Pediatric Cardiology

Biography

Biography: Richard Kirk

Abstract

The new international heart failure guidelines (Kirk et al. J Heart Lung Transplant 2014) are a big step forward in the management of heart failure however for some children medical management is insufficient and mechanical support, transplantation or palliative care are the only choices.
Extra-corporeal membrane oxygenation (ECMO) is lifesaving when a patient “crashes and burns” but cannot provide the length of time necessary to find a donor for most patients. Mechanical supports through the use of 1st generation devices (e.g. Berlin Heart) to 3rd generation devices (e.g. Heart ware) are thus increasingly important. Whilst not without risk they provide long term support and for the latest devices management at home is achievable. They are also leading to a paradigm shift in management as it is clear that recovery can occur in a significant number of children and avoid the need for transplantation.
Transplantation however remains for now the most realistic means of offering a high quality and long length of life for those in end stage heart failure. In the best hands the average length of donor organ survival is now 25 years. Re-transplantation is currently the only realistic option when the donor heart fails but implantable devices or tissue engineering and stem cell technology are already on the near horizon.