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Published on: September 21, 2021
Changing patterns of bridging to heart transplantation in children
Jane Cassidy1, Simon Haynes, Richard Kirk
1Freeman Hospital, Newcastle upon Tyne, UK. jane.cassidy@nuth.nhs.uk
Insights
Mechanical support helps children awaiting heart transplants, with improved devices enabling longer support. However, neurologic events remain a significant cause of mortality, highlighting a critical area for future research and intervention.
Area of Science:
- Pediatric Cardiology
- Cardiothoracic Surgery
- Transplantation Medicine
Background:
- Mechanical circulatory support is an established treatment for pediatric heart failure awaiting transplantation.
- Advancements in device technology have extended support duration, but donor organ scarcity persists.
- Significant morbidity is associated with prolonged mechanical support in pediatric patients.
Purpose of the Study:
- To evaluate the outcomes of mechanical support as a bridge to pediatric heart transplantation over a 10-year period.
- To compare the efficacy and safety of different mechanical support devices used in pediatric patients.
- To identify trends and challenges in pediatric heart transplantation, including waiting times and mortality causes.
Main Methods:
- Retrospective review of pediatric patients receiving mechanical support for heart transplantation at a UK center.
- Comparison of outcomes between two distinct time periods: 1998-2002 and 2003-2007.
- Analysis of survival rates, duration of support, and causes of mortality, including neurologic events.
Main Results:
- Survival to transplant or recovery was 71% (29/41), with 63% (26/40) surviving to hospital discharge.
- The Berlin Heart device demonstrated longer support durations (median 44 days) with a 77% survival rate to transplant or recovery.
- Neurologic events were the predominant cause of death in both study periods, irrespective of the support device used.
Conclusions:
- Increasing waiting times for pediatric cardiac transplantation in the UK necessitate effective bridging strategies.
- The Berlin Heart facilitates extended mechanical support, improving outcomes for children awaiting heart transplants.
- Addressing neurologic morbidity remains a critical challenge in the management of pediatric patients on mechanical support.
Background:
Mechanical support as a bridge to cardiac transplantation in children is an accepted treatment. With improved devices and increasing experience, the length of time that children can be supported has increased. Donor organs remain scarce and there is significant associated morbidity.
Methods:
Retrospective review of all children offered mechanical support as a bridge to heart transplant over 10 years in one of the two UK pediatric heart transplant centers. Outcomes during the years 1998 to 2002 were compared with outcomes during the years 2003 to 2007.
Results:
Forty children in 41 separate patient episodes received mechanical support as a bridge to transplantation or, in 1 case, to recovery. Survival to transplant or recovery was achieved in 29 of 41 (71%); 26 of 40 children (63%) survived to hospital discharge. Devices used were extracorporeal membrane oxygenation (ECMO), the Medos HIAA, the Berlin Heart (from November 2005) and the Levitronix ventricular assist device (VAD) from 2007. All 3 children supported with the Levitronix survived to transplant (median duration of support 10 days). Ten of 13 children (77%) supported by the Berlin Heart survived to transplant or recovery (median duration of support 44 days). Four of 7 (57%) children supported using the Medos device survived to transplant (median duration of support 7 days). Neurologic events were the most common cause of death in both eras (1998 to 2002 and 2003 to 2008).
Conclusions:
Waiting times to pediatric cardiac transplant in the UK have increased. The Berlin Heart allows children to be bridged to transplant over long periods. Neurologic morbidity remains as a major concern.
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