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Berlin Heart EXCOR as a Bridge to Transplantation in Pediatric End-Stage Heart Failure: A Retrospective Cohort Study
Mohannad Dawary1, Dimpna Brotons2, Felix W Tsai2
1Cardiac Surgery, Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh 13338, Saudi Arabia.
Insights
The Berlin Heart EXCOR effectively bridges pediatric heart failure patients to transplantation, achieving a high success rate despite significant complications and prolonged hospital stays. This ventricular assist device offers a viable option for mechanical circulatory support in children.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Cardiac Surgery
Background:
- End-stage heart failure in children necessitates advanced interventions like ventricular assist devices.
- The Berlin Heart EXCOR is a critical option for bridging pediatric patients to heart transplantation.
- Evaluating the outcomes of Berlin Heart EXCOR in pediatric end-stage heart failure is essential.
Purpose of the Study:
- To assess the effectiveness of the Berlin Heart EXCOR as a bridge to transplantation in pediatric patients.
- To analyze complications, hospitalization duration, and survival rates associated with Berlin Heart EXCOR support.
- To determine the Berlin Heart EXCOR's viability for pediatric end-stage heart failure management.
Main Methods:
- Retrospective analysis of 11 pediatric patients implanted with the Berlin Heart EXCOR.
- Data collected from November 2021 to April 2025, including patient demographics and INTERMACS class.
- Evaluation of device configuration (LVAD, BiVAD), complications, and transplantation outcomes.
Main Results:
- 90.90% of patients had dilated cardiomyopathy; 72.73% were INTERMACS class I.
- High rates of complications including stroke (27.27%), bleeding (27.27%), and pneumonia (36.36%).
- 90.91% achieved successful bridge to transplantation; 3-year survival rate was 67.50%.
Conclusions:
- The Berlin Heart EXCOR is effective for pediatric mechanical circulatory support, enabling high bridge-to-transplantation rates.
- Despite complications and extended hospital stays, it offers acceptable mid-term survival.
- Supports the use of Berlin Heart EXCOR as a viable bridge to transplantation for pediatric end-stage heart failure.
Background:
Ventricular assist devices serve as a critical bridge to transplantation for pediatric patients with end-stage heart failure. This study evaluated the outcomes of pediatric patients who received Berlin Heart EXCOR support for end-stage heart failure.
Methods:
We retrospectively analyzed data from 11 consecutive pediatric patients (63.64% male, median age 60 months) who underwent Berlin Heart implantation from November 2021 to April 2025. The majority (90.90%) had dilated cardiomyopathy, and 72.73% were INTERMACS class I.
Results:
Of the 11 patients, 54.54% received an LVAD only, 36.36% received a BiVAD, and 9.09% required an LVAD followed by an RVAD. The postoperative mean ICU stay was 140 ± 73 days, and total hospital stay was 192 ± 96 days. Significant post-implant complications included stroke (27.27%), bleeding requiring exploration (27.27%), and pneumonia (36.36%). Ten patients (90.91%) were successfully bridged to heart transplantation, with one pre-transplant mortality (9.09%) due to brain hemorrhage. The median time to transplantation was 88 days (interquartile range, IQR: 78-177). During a median follow-up of 17 months (IQR: 7-32), two patients died post-transplant, resulting in an overall survival rate of 67.50% at 3 years.
Conclusions:
Despite significant complications and prolonged hospitalization, the Berlin Heart demonstrated effectiveness as a mechanical circulatory support device for pediatric patients, with a high rate of successful bridging to transplantation and acceptable mid-term survival. These findings support its use as a viable bridge to transplantation in pediatric end-stage heart failure.
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