HJAR May/Jun 2024

36 MAY / JUN 2024 I  HEALTHCARE JOURNAL OF ARKANSAS ADH CORNER COLUMN CHILDREN’S HEALTH MacKenzie Maddry, 16, is the first pedi- atric patient in Arkansas to go home on a ventricular assist device (VAD), specifically a HeartMate 3 left VAD (LVAD), under the ex- pertise of the cardiac surgery and cardiology teams at Arkansas Children’s Heart Institute in Little Rock. The heart institute has placedmore than 65 pediatric VADs, including traditional pneu- matic-driven pumps like the Berlin Heart EXCOR, centrifugal pumps like the Heart- Mate 3, and the total artificial heart system SynCardia. The heart institute’s teamhas also successfully placed percutaneous VADs for single-ventricular and bi-ventricular support. The HeartMate 3 is the newest technol- ogy of centrifugal pumps using MagLev Flow technology. A VAD provides cardiac output, protecting other organs and allowing for more physical activity tomaintain health and vitality while waiting for a heart transplant. Several variables impact how long a patient uses a VAD, including patient size, sex, and blood type, in addition to variables related to cross-reactivity between recipient and donor, as well as challenging anatomy and previous complex congenital heart surgeries, which add a level of complexity to both pre- and postoperative cardiac transplant care. While sending a patient home rather than keeping them in the hospital on a VAD is oc- curring more often in the adult population, it is not universally available to our pediat- ric patients. It relies on an expert team to provide proper training and monitoring to community medical teams and the patient’s family to ensure patient safety. While most VAD programs that send pa- tients home require the patient to stay within the local area, Maddry’s home in Bella Vista is a six-hour roundtrip drive fromArkansas Children’s Hospital (ACH). Maddry’s case was a multidisciplinary partnership between oncology, orthopedics, and cardiology service lines. Maddry had an extensive care team for cardiac surgery and cardiology including myself; Brian Reemtsen, MD, director of the Arkansas Children’s Heart Institute, chief of cardiovascular surgery at ACH, and professor of surgery at the University of Arkansas for Medical Sciences (UAMS); and Kenneth Knecht, MD, medical director of the ACH Heart Transplant and Advanced Heart Fail- ure Program at ACH and a professor of pe- diatrics at UAMS. Osteosarcoma and orthopedics In 2020, Maddry was diagnosed with os- teosarcoma. She received 21 cycles of che- motherapy treatment under the care of David Douglass, MD, a pediatric oncologist at ACH and assistant professor at UAMS. Though chemotherapy cleared most of the cancer, in April 2021, Maddry had part of her femur removed and replaced with a cadaver bone by Corey Montgomery, MD, an orthopedic oncologist at ACH and associate professor of orthopedics at UAMS. He is the only or- thopedic oncologist inArkansas and the only surgeon in the state to perform this type of surgery. Maddry’s family opted for the cadaver bone to preserve her joint and flexibility rath- er than a metal or plastic prosthesis. Starting ARKANSAS CHILDREN’S HEART INSTITUTE Sends First Pediatric Patient in the State Home on a VAD