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Outcomes in small children on Berlin Heart EXCOR support: age and body surface area as clinical predictive factors
Sofie Rohde1, Eugen Sandica2, Kevin Veen1
1Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Insights
The Berlin Heart EXCOR (BHE) is effective for pediatric patients, with high recovery rates in the smallest children (BSA <0.53 m2). Age and body surface area (BSA) do not predict mortality in BHE-supported patients.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Medical Device Outcomes
Background:
- The Berlin Heart EXCOR (BHE) provides circulatory support for pediatric patients.
- Outcomes and care requirements for BHE support vary significantly across different pediatric age groups.
- Understanding age- and size-related outcomes is crucial for optimizing BHE therapy.
Purpose of the Study:
- To analyze age- and body surface area (BSA)-related outcomes in pediatric patients receiving Berlin Heart EXCOR (BHE) support.
- To identify factors influencing mortality, transplant rates, and recovery in this patient cohort.
- To evaluate the efficacy of BHE across diverse pediatric age and size categories.
Main Methods:
- Utilized data from the EUROMACS database for patients <19 years old supported by BHE between 2000 and 2021.
- Employed maximally selected rank statistics to determine critical body surface area (BSA) cut-off values.
- Conducted multivariable Cox proportional hazard regression with ridge penalization to identify outcome predictors.
Main Results:
- A total of 303 patients were analyzed (mean age: 2.0 years).
- Mortality was not significantly associated with age or BSA (P > 0.67).
- Higher transplant rates were linked to older age (HR 1.07, P=0.006) and non-congenital heart disease etiology (HR 1.46, P=0.020).
- Recovery rates were highest in patients with BSA <0.53 m2 (21.8% at 1 year).
- Patients with BSA ≥0.73 m2 showed lower early pump thrombosis risk but higher early bleeding risk compared to those with BSA <0.73 m2.
Conclusions:
- Patient age and BSA do not predict mortality in Berlin Heart EXCOR support.
- The BHE demonstrates remarkably high recovery rates in the smallest pediatric patients (BSA <0.53 m2).
- The BHE is a viable and effective therapeutic option for even the youngest and smallest pediatric patients requiring circulatory support.
Objectives:
The Berlin Heart EXCOR (BHE) offers circulatory support across all paediatric ages. Clinically, the necessary care and the outcomes differ in various age groups. The EUROMACS database was used to study age- and size-related outcomes for this specific device.
Methods:
All patients <19 years of age from the EUROMACS database supported with a BHE between 2000 and November 2021 were included. Maximally selected rank statistics were used to determine body surface area (BSA) cut-off values. Multivariable Cox proportional hazard regression using ridge penalization was performed to identify factors associated with outcomes.
Results:
In total, 303 patients were included [mean age: 2.0 years (interquartile range: 0.6-8.0, males: 48.5%)]. Age and BSA were not significantly associated with mortality (n = 74, P = 0.684, P = 0.679). Factors associated with a transplant (n = 175) were age (hazard ratio 1.07, P = 0.006) and aetiology other than congenital heart disease (hazard ratio 1.46, P = 0.020). Recovery rates (n = 42) were highest in patients with a BSA of <0.53 m2 (21.8% vs 4.3-7.6% at 1 year, P = 0.00534). Patients with a BSA of ≥0.73 m2 had a lower risk of early pump thrombosis but a higher risk of early bleeding compared to children with a BSA of <0.73 m2.
Conclusions:
Mortality rates in Berlin Heart-supported patients cannot be predicted by age or BSA. Recovery rates are remarkably high in the smallest patient category (BSA <0.53 m2). This underscores that the BHE is a viable therapeutic option, even for the smallest and youngest patients.
