A modified implantation technique of the HeartWare ventricular assist device for pediatric patients

Limitations to our study include the lack of a control group or a different treatment arm. Owing to recurrent, lifethreatening, and refractory bleeding in these patients, we concluded that withholding a therapy that we had previously shown would benefit these patients would be unethical. We also did not assess the relative effect of thalidomide in reduction of LVAD-associated GIAD compared with other therapeutic agents. Other investigators have used agents, including octreotide, to reduce bleeding due to GIAD in LVAD patients, although octreotide is difficult to tolerate due to its mode of delivery (injection) and adverse effects, including nausea and bradycardia. Lenalidomide, a synthetic analog of thalidomide, has been shown to be as potent as the parent drug, with less of the non-hematologic adverse effects, and is another potential treatment option for these patients. In summary, thalidomide can be used safely in patients with LVAD-associated GIAD when prescribed as part of a treatment protocol. These findings must be replicated in multicenter, randomized studies to corroborate our results. Disclosure statement