Treatment of Terminal Heart Failure and Cardiogenic Shock in 36 Children Less than 10 Kg Body Weight Assisted by Berlin Heart Excor Device

Abstract

Background: Since the first implantation of a pulsatile paediatric ventricular assist device (VAD, Berlin Heart) in a child in 1990 at our institution outcome has significantly improved, with the implementation of optimized cannulas, modified anticoagulation and optimized surgical and intensive care management since 1999. We present our clinical experience with the Berlin Heart Excor device since 1999 in children with a body weight less than 10 kg. Methods: We performed a retrospective case analysis of all children less than 10 kg body weight who were treated with the Berlin Heart Excor since January 1st 1999 until February 5th 2012. Results: Thirty-six infants, age 0 - 27 months (median 6 mo), weight 3.2 - 9.9 kg (median 6.1 kg), were treated with VAD. Median time on support was 35 days (1 - 418 d). Twenty-nine children had left VAD and seven children biventricular VAD support systems. All children suffered from terminal heart failure with multiorgan failure or cardiogenic shock. Twenty-two had cardiomyopathy, five suffered from fulminant myocarditis and nine had a preceding operation on cardiopulmonary bypass. Procedural success was achieved in 72 % of children: 10 could be weaned from the system, another 15 patients received successful heart transplantation, 10 infants died and one is still on mechanical support. All patients with fulminant myocarditis were weaned from the assist system. At follow-up 1 year after explantation (n=24) the statomotoric development was normal or near normal in 21 of the 24 surviving children. In the seven children in whom thromboembolic events occurred two had mild to moderate hemiparesis, two severe statomotoric retardation and two recovered completely at follow-up examination. One child died 11 months after successful heart transplantation due to pneumonia. Conclusion: With a total survival rate of 72% the outcome of VAD support in small children is comparable to that in older children. The Berlin Heart Excor device is now a well-established treatment for small children suffering from cardiogenic shock of any aetiology.