A Valentine Story
Although the Centrimag device has been used before, and is FDA approved in adults as a blood pumping system, this is one of the first times it has been used as a VAD on a child in the United States.
Six-year-old Seth Breese has a smile that could melt your heart. And speaking of hearts, Seth has a brand new one, transplanted in September by Dr. Peter Wearden of Children’s Hospital of Pittsburgh of UPMC and due to the generosity of a donor family.
Seth’s story actually begins when he was diagnosed soon after birth with dilated cardiomyopathy—a condition in which the heart is weakened and enlarged and cannot pump blood efficiently. In a recent conversation with Seth’s mother, Kim Breese, she stated, “We knew from birth that Seth would eventually need a heart transplant, but until last year his body was coping.”
Last summer Seth began to feel lethargic and was unable to eat and do other normal activities. He was brought to Children’s Hospital and listed on the transplant list in mid-August. Because of the fact that Seth’s condition was deteriorating and the heart output was low, he first underwent surgery to place a VAD (ventricular assist device) called the Centrimag Blood Pumping System, manufactured by Levitronix, LLC.
The reason that Seth’s case is making medical news is that although the Centrimag device has been used before, and is FDA approved in adults as a blood pumping system, this is one of the first times it has been used as a VAD on a child in the United States and the first time it has ever been used at Children’s Hospital of Pittsburgh.
Much of the preclinical testing of this VAD was done by researchers and faculty at the McGowan Institute for Regenerative Medicine including Harvey Borovetz, PhD and the surgeon in charge of Seth’s case, Peter Wearden, MD, an assistant professor in Pediatric Cardiac Surgery and Director of Pediatric Mechanical Cardiopulmonary Support at Children’s. Dr. Kurt Dasse of Levitronix was the developer and designer of the device.
Dr. Borovetz has made the development of a pediatric VAD one of his personal and professional goals. In discussing the history of these cardiac support devices he states, “The first ECMO [utilization] for cardiac support in an infant was performed in 1977. Thirty years later, exciting new technology is becoming available for these patients, and the McGowan Institute for Regenerative Medicine’s participation is helping to make this possible.”
The ECMO that Dr. Borovetz (Chair of the Bioengineering Department at the University of Pittsburgh and Deputy Director of Artificial Organs and Medical Devices at McGowan Institute) refers to is the Extracorporeal Membrane Oxygenation device, first utilized at Children’s Hospital in the 1970s when a child with critically low cardiac output was supported following the repair of complex congenital heart defects. ECMO is also used for short-term support of children with severe cardio-respiratory problems awaiting a heart transplant. The negative aspects of the ECMO are that it has a mortality rate of one out of three, carries significant bleeding risks, requires the child to be under a constant general anesthetic, and is the size of a home freezer on wheels. All of this prohibits a parent’s ability to interact with a child.
A VAD is a much smaller electrically-powered pump that can be implanted and used to support an ailing heart. It can also be used as a bridge between the onset of severe heart problems and a heart transplant. Although the ECMO could have been used in Seth’s case, the Centrimag Blood Pumping System was a better option.
The Centrimag is a continuous-flow, centrifugal-type rotary blood pump that is placed outside the body. The pump housing and rotor are made of medical-grade polycarbonate, designed for single-use. The centrifugal pump design permits rotation of the impeller (the only moving part inside the pump) at lower speeds, while still achieving desired flow rates. The Centrimag causes very little damage to the blood because it does not contain any bearings or seals—components that are known to cause destruction of red blood cells and promote blood clot formation.
Seth had the Centrimag implanted for approximately one week. Over that period, his heart had time to rest and heal, and doctors were able to remove the device. But Seth’s condition slowly began to worsen a week later. While the transplant team was en route to procure his new heart, Seth was placed on ECMO for several hours to stabilize him for transplantation.
McGowan and Children’s researchers will continue their efforts to develop a pediatric VAD. Seth’s case was a special one that permitted the use of the adult Centrimag on a child, but there are various other clinical trials currently underway at the Children’s Heart Center to provide improved protocols and better methods of sustaining circulation during cardiorespiratory decompensation in infants and children. Drs. Borovetz, Wearden, Dasse and Dr. Steven Webber, Chief of Pediatric Cardiology and Director of Pediatric Heart Transplantation, Children’s Hospital of Pittsburgh, are currently collaborating on a project funded by the National Heart Lung and Blood Institute to adapt the Centrimag’s unique technology to a new system, the PediVAS, to be used in babies and small children.
In speaking about what was learned in Seth’s case, Dr. Wearden said, “Interestingly, Seth’s heart recovered over a week and we were able to remove the device, but then his heart…began to fail again. This raises interesting questions about the potential for recovery, without transplantation, as we improve these devices and their management for safer and longer term use.”
These days, Seth is once more enjoying his life as a six-year-old. According to his parents, Kim and Jarrod of Greenville, Mercer County, Seth’s favorite activities include playing video games, watching TV, and like a typical little brother, irritating his sister, McKenna, age eight. With the reappearance of Seth’s smile over the last few months, there is no question that Valentine’s Day at the Breese household this year will take on a whole new meaning.