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Berlin cannulation with an outflow interposition graft-a versatile technique.

Richard C Tang1, Junsang Cho1, Yishay Orr1

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Summary

A modified Berlin Heart EXCOR VAD outflow using a long interposition graft improved outcomes in complex heart failure patients. Expanded polytetrafluoroethylene grafts are preferred due to reduced hemolysis and better performance.

Keywords:
congenital heart diseasemechanical circulatory supportpediatric heart failureventricular assist device

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Area of Science:

  • Pediatric cardiology
  • Mechanical circulatory support
  • Congenital heart disease

Background:

  • The Berlin Heart EXCOR VAD is crucial for complex pediatric heart failure.
  • Conventional arterial cannulas present challenges with variable patient anatomy.

Purpose of the Study:

  • To evaluate the efficacy of a modified Berlin Heart EXCOR VAD outflow using a long interposition graft.
  • To assess outcomes in patients with complex arterial anatomy requiring VAD support.

Main Methods:

  • Single-center retrospective review of 50 consecutive patients undergoing modified Berlin cannulation.
  • Analysis of patient demographics, etiologies, graft materials, outflow targets, and clinical outcomes.
  • Comparison of outcomes between expanded polytetrafluoroethylene and Dacron grafts.

Main Results:

  • 82% of patients (41/50) achieved favorable outcomes, including 30 transplants and 8 ongoing support.
  • Congenital heart disease (52%) and cardiomyopathy (48%) were primary etiologies.
  • Expanded polytetrafluoroethylene grafts showed lower rates of hemolysis (14% overall) compared to Dacron, especially in patients with high stroke volume.

Conclusions:

  • The long interposition graft technique provides versatility for VAD outflow in complex pediatric cases.
  • Expanded polytetrafluoroethylene is the preferred graft material due to its smooth surface and reduced hemolysis.
  • Careful selection of graft material and size is essential for optimizing VAD outcomes.