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Pediatric assist with the Medos and Excor systems in small children
Christof Schmid1, Volker Debus, Wiebke Gogarten
1Department of Thoracic and Cardiovascular Surgery, University Hospital Münster, Münster, Germany.
Insights
Pediatric paracorporeal assist devices offer a viable bridge to transplantation for critically ill children. These mechanical circulatory support systems demonstrate potential for improved quality of life and manageable complications in young patients.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Cardiothoracic Surgery
Background:
- Pediatric long-term ventricular support using paracorporeal assist devices is a specialized procedure with limited institutional experience.
- Neonates, infants, and small children with end-stage heart failure often require advanced mechanical circulatory support.
Purpose of the Study:
- To report the experience and outcomes of implanting paracorporeal assist devices in pediatric patients.
- To evaluate the feasibility, safety, and efficacy of long-term mechanical support in neonates, infants, and small children.
Main Methods:
- A retrospective review of seven pediatric patients (2 weeks to 6 years) who received either a Medos or BerlinHeart Excor paracorporeal assist device.
- Patients presented with severe heart failure (New York Heart Association class IV), including dilated cardiomyopathy, endocardial fibroelastosis, Ebstein anomaly, and post-aortic valve replacement.
Main Results:
- Six patients (87.5%) successfully bridged to heart transplantation.
- Neonates required reexploration for bleeding and mediastinal clots; severe thromboembolic events were noted in this subgroup.
- Older infants experienced an uneventful perioperative course with good end-organ function recovery.
Conclusions:
- Long-term mechanical support with paracorporeal assist devices is feasible in pediatric patients, including neonates and infants.
- These devices can provide a bridge to transplantation, offering a high quality of life with an acceptable complication rate.
- Careful patient selection and management are crucial, particularly regarding thromboembolic events in neonates.
Abstract:
Pediatric long-term ventricular support with paracorporeal assist devices is performed in only a few institutions. We report on our experience with two pediatric paracorporeal devices, which have been implanted in neonates, infants, and small children. Seven children with ages ranging from 2 weeks to 6 years and a body weight of 3 to 19 kg were provided with either a Medos or a BerlinHeart System. The underlying heart diseases included dilative cardiomyopathy (n = 3), endocardial fibroelastosis (n = 2), Ebstein anomaly, and status post redo aortic valve replacement (n = 1). All children were in New York Heart Association class IV and were inotrope dependent. Three children were provided with a Medos system and 4 children with a BerlinHeart Excor device. In 6 cases, left ventricular support, and in 1 case, right ventricular support was performed. All patients were stabilized with univentricular mechanical support. The perioperative course was uneventful, and end-organ function was well recovered. Reexploration for bleeding and evacuation of mediastinal blood clots was necessary in all three neonates but not in any of the older infants. Severe thromboembolic events were only noticed in the neonates. Successful bridge to transplantation was performed in 6 of the 7 patients (87.5%). Our late results have been quite encouraging, as they readily prove that pediatric long-term mechanical support is possible with a high quality of life and an acceptable low complication rate.
