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Pediatric Ventricular Assist Device Support in the Netherlands.
Sofie Rohde1, Christiaan F J Antonides1, Rahatullah Muslem1
1Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
World Journal for Pediatric & Congenital Heart Surgery
|April 16, 2020
Summary
The Berlin Heart EXCOR improved survival for pediatric heart failure patients, though cerebrovascular accidents became a leading cause of death. Further studies are needed to confirm these findings.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Heart Transplantation
Background:
- Pediatric end-stage heart failure presents significant mortality challenges.
- The Berlin Heart EXCOR (BH EXCOR) is a ventricular assist device (VAD) for pediatric patients awaiting heart transplantation (HTx).
- Evaluating the impact of new VAD technology on waiting list outcomes is crucial.
Purpose of the Study:
- To assess changes in heart transplantation waiting list mortality after the introduction of the BH EXCOR.
- To investigate the incidence of adverse events in pediatric patients supported with the BH EXCOR.
Main Methods:
- Retrospective, single-center study design.
- Inclusion of all pediatric patients (≤18 years) awaiting HTx.
- Comparison of two eras: pre-BH EXCOR (1998-2006) and post-BH EXCOR (2007-2018).
Main Results:
- A trend towards reduced overall mortality was observed in the BH EXCOR era (22% vs. 47%, P=.06).
- Transplantation rates did not differ significantly between eras (65% vs. 53%, P=.39).
- Cerebrovascular accidents (CVAs) emerged as the predominant cause of death in the BH EXCOR era (29%), with bleeding complications also frequent (50%).
Conclusions:
- The BH EXCOR has positively influenced survival for pediatric patients with end-stage heart failure.
- The primary cause of death shifted from heart failure to CVAs after BH EXCOR implementation.
- Prospective, registry-based studies are recommended to validate these findings.
