Abstract
Objective: Despite the improvement in ventricular assist device (VAD) therapy in adults and in adolescents, in infant population only Berlin Heart EXCOR (BHE) is licensed as long term VAD to bridge children to Heart Transplantation (HTx). Particularly demanding in terms of morbidity and mortality are smallest patients namely the ones implanted in the first year of life or with a lower body surface area. This work aims at retrospective reviewing a single center experience in using BHE in children with a body weight under 10 kg.Methods: Data of all pediatric patients under 10 kg undergoing BHE implantation in our institution from March 2002 to March 2016 were retrospectively reviewed.Results: Of the 30 patients enrolled in the study, 53% were male, 87% were affected by a dilated cardiomyopathy with an average weight and age at the implantation of 6.75 ± 2.16 Kg and 11.57 ± 10.12 months, respectively. Three patients (10%) required a BIVAD implantation. After the implantation, 7 patients (23%) required re-intervention for bleeding and 9 patients (30%) experienced BHE cannulas infection. A total of 56 BHE pump were changed for thrombus formation (1.86 BHE pump for patient). The average duration of VAD support was 132.8 ± 94.4 days. Twenty patients (67%) were successfully transplanted and 10 patients (33%) died: 7 for major neurological complication and 3 for sepsis.Conclusion: Mechanical support in smaller children with end stage heart failure is an effective strategy for bridging patients to HTx. The need for BIVAD was relegated, in the last years, only to restrictive cardiomiopathy. Further efforts are required in small infants to improve anticoagulation strategy to reduce neurological events and BHE pump changes.
Highlights
The definitive treatment for the end stage pediatric heart failure is the orthotopic heart transplantation (OHTx)
Increasing the left VADs (LVAD) cardiac output it is possible to obtain an increment of the total cardiac output and a higher unloading of the left ventricle (LV) with lower LV volumes, lower left atrial pressure, lower pulmonary pressure and lower LV output
Conway et al reported about the outcome of a multicenter study on 97 pediatric patients under 10 kg undergoing Berlin Heart EXCOR ventricular assist device (VAD)
Summary
The definitive treatment for the end stage pediatric heart failure is the orthotopic heart transplantation (OHTx). The use of left VADs (LVAD) could successfully support patients till the OHTx, increasing the cardiac output (CO), unloading the left ventricle (LV) and decreasing the left atrial pressure and the pulmonary arterial pressure. Increasing the LVAD cardiac output (increasing the LVAD speed in the continuous flow LVAD or increasing the pump rate in pulsatility flow LVAD) it is possible to obtain an increment of the total cardiac output (untill a determined plateau) and a higher unloading of the LV with lower LV volumes, lower left atrial pressure, lower pulmonary pressure and lower LV output. In the case of total support, all the cardiac output is totally provided by the LVAD and the aortic valve remains closed. This condition is usually avoided to permit to the LV at least a slight ejection and to the aortic valve to open at least every three cardiac cycle
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