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Long-Term Mechanical Circulatory Support in Pediatric Patients
Eugen Sandica1, Ute Blanz1, Lotfi Ben Mime1
1Department of Surgery for Congenital Heart Defects, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany.
Insights
Pediatric patients using Berlin Heart EXCOR and HeartWare ventricular assist systems achieved excellent survival rates. Long-term mechanical circulatory support demonstrated a low incidence of adverse events in children with complex heart conditions.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Mechanical circulatory support (MCS) is crucial for pediatric patients with end-stage heart failure.
- Ventricular assist devices (VADs) offer a bridge to transplant or recovery.
- Evaluating long-term outcomes of different VADs in pediatric populations is essential.
Purpose of the Study:
- To review the long-term outcomes of pediatric patients supported by two different VAD systems: Berlin Heart EXCOR and HeartWare.
- To compare the efficacy, survival rates, and adverse events associated with each VAD system.
Main Methods:
- Retrospective study of pediatric patients implanted with Berlin Heart EXCOR (n=29) and HeartWare (n=9) systems between January 2008 and April 2014.
- Analysis of patient demographics, support duration, transplant status, recovery, mortality, and complications.
- Inclusion of patients with biventricular and single-ventricle physiology.
Main Results:
- Berlin Heart EXCOR group: 65.5% transplanted, 20.7% recovered, 89.7% survival rate. Complications included pump exchanges, infection (13.8%), and neurological events (10.3%).
- HeartWare group: 88.9% transplanted, 88.9% survival rate. Complications included infection (44.4%) and neurological events (33.3%).
- Both systems demonstrated excellent survival possibilities in pediatric patients, including those with single-ventricle physiology.
Conclusions:
- Long-term mechanical circulatory support is a viable option for pediatric patients with two- and single-ventricle physiology.
- Both Berlin Heart EXCOR and HeartWare systems can achieve excellent survival rates with manageable adverse event profiles.
- Further research into optimizing VAD therapy in pediatric populations is warranted.
Abstract:
This retrospective study reviews our results regarding the long-term support in pediatric patients using two ventricular assist systems between January 2008 and April 2014. We implanted the Berlin Heart EXCOR in 29 patients (median age 3.4 years [interquartile range (IQR) 0.2-16.5], median weight 13 kg [IQR 4.2-67.2]). Twenty-two patients (75.8%) received a left ventricular assist device. Three patients (10.3%) had single-ventricle physiology. One patient (3.4%) had mechanical mitral valve prosthesis. The HeartWare System was implanted in nine patients. The median age was 15.6 years (IQR 12.2-17.9), and the median weight was 54.9 kg (IQR 27.7-66). In the Berlin Heart group, the median support time was 65 days (IQR 4-619), with 3647 days of cardiac support. Nineteen patients (65.5%) were transplanted, six patients (20.7%) recovered, one patient (3.4%) is on support, and three patients (10.3%) died on support. Survival rate was 89.7%. Fourteen blood pumps had been exchanged. Four patients (13.8%) had local signs of infection, and three patients (10.3%) had neurological complications. In the HeartWare group, the median support time was 180 days (IQR 1-1124), with 2839 days of cardiac support. Four patients (44.4%) had local signs of infection, and three (33.3%) had neurological complications. Eight patients (88.9%) have been transplanted, and one patient (11.1%) died on support. Survival rate was 88.9%. Excellent survival is possible after long-term mechanical circulatory support in patients with two- and single-ventricle physiology with a low rate of adverse events.
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