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Updated: Jul 20, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Improvement in survival after mechanical circulatory support with pneumatic pulsatile ventricular assist devices in
Roland Hetzer1, Evgenij V Potapov, Brigitte Stiller
1Deutsches Herzzentrum Berlin, Berlin, Germany. hetzer@dhzb.de
Insights
Improvements in pediatric ventricular assist devices (VAD) have significantly increased survival and discharge rates in children, particularly those under one year old. These advancements make VADs a crucial option for pediatric cardiogenic shock.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Cardiovascular Surgery
Background:
- Pediatric pneumatically driven extracorporeal ventricular assist devices (VAD) were introduced in 1992, with initial poor outcomes in infants.
- Significant improvements in VAD technology and management have been implemented since the initial period.
- These include enhancements in cannulas, connectors, pump coatings, anticoagulation, and earlier surgical intervention.
Purpose of the Study:
- To compare the outcomes of pediatric VAD implantation in two distinct time periods at a single institution.
- To evaluate the impact of technological and management improvements on patient survival and discharge rates.
- To assess the effectiveness of the Berlin Heart Excor VAD in infants and children with cardiogenic shock.
Main Methods:
- A retrospective analysis of 62 Berlin Heart Excor VAD implantations in patients under 18 years old.
- Patients were divided into two groups: Period 1 (1990-1998, n=34) and Period 2 (1999-2004, n=28).
- Comparison of preoperative data, support duration, VAD configuration, chest closure, extubation, and survival rates between the two periods.
Main Results:
- Longer support duration was observed in Period 2 (53.2 days) compared to Period 1 (17.9 days).
- Increased use of left VADs and higher rates of primary chest closure and extubation on VAD support were noted in Period 2.
- Survival and discharge rates significantly improved in Period 2 (68%) versus Period 1 (35%), with notable gains in infants and patients with specific heart conditions.
Conclusions:
- Earlier VAD implantation, combined with technological and management refinements, has dramatically improved survival and discharge rates in pediatric patients.
- The pediatric Berlin Heart Excor VAD is a proven, valuable therapeutic option for children experiencing cardiogenic shock, serving as a bridge to transplantation or recovery.
- Outcomes for infants under one year old showed particular improvement, achieving survival rates comparable to older children in the later treatment period.
Background:
Pediatric size pneumatically driven extracorporeal ventricular assist devices (VAD) for infants and small children were introduced into clinical routine in 1992. In the initial period, the results in infants were poor. Since then, several improvements have been introduced with regard to the cannulas, connectors, heparin coating of the blood pump inner surface, anticoagulant treatment and coagulation monitoring, and earlier decision-making in favor of pump implantation before irreversible shock has set in.
Methods:
Since 1990 and as of January 1, 2005, 62 Berlin Heart Excor systems have been implanted in patients below 18 years of age at our institution. The patients were divided into two groups according to the period of treatment: period 1, devices implanted between 1990 and 1998 (n = 34), and period 2, devices implanted between 1999 and 2004 (n = 28). We compared our experience during the earlier and later periods.
Results:
There were no significant differences in the preoperative patient data between the two periods except for time of support (17.9 +/- 27.7 days versus 53.2 +/- 83.9 days, p = 0.001). In period 1, more patients needed a biventricular VAD whereas in period 2, more patients were effectively treated with a left VAD (p = 0.05). In the later period, the chest could be primarily closed in a significantly higher percentage of infants (0% versus 89%, p = 0.012), and more infants could be extubated on the VAD (0% versus 55%, p = 0.16). Discharge from the hospital after either weaning from the system or heart transplantation was achieved for 35% in period 1 and for 68% in period 2 (p = 0.029). Whereas in period 1 there were no survivors in the group of children younger than 1 year old, during period 2, survival in this age group was similar to that of the two groups of older children (p = 0.024). There was a significant improvement in the discharge rate in period 2 in patients with cardiomyopathy (43% versus 76%, p = 0.045) and postcardiotomy heart failure (0% versus 57%, p = 0.01).
Conclusions:
Earlier implantation of VADs, heparin coating of the blood pumps, and substantial modifications in cannula design, anticoagulation, and the coagulation monitoring regimen have led to a significant increase in the survival and discharge rate, especially among children under 1 year of age. The pediatric size Berlin Heart Excor VAD is a valuable option as a bridge to heart transplantation or recovery for children suffering from cardiogenic shock.
