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Circulatory support with paracorporeal pneumatic ventricular assist device (VAD) in infants and children
K Ishino1, M Loebe, F Uhlemann
1Department of Thoracic and Cardiovascular Surgery, German Heart Institute, Berlin.
Insights
The pneumatic Berlin Heart ventricular assist device (VAD) shows feasibility in pediatric patients with severe heart failure. This VAD can sustain children for extended periods, offering a bridge to transplantation or supporting myocardial recovery.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Cardiothoracic Surgery
Background:
- Profound cardiogenic shock in children often requires advanced support beyond conventional therapies.
- Ventricular assist devices (VADs) offer a potential solution for pediatric end-stage heart failure.
- The Berlin Heart pneumatic VAD is a device used for pediatric mechanical circulatory support.
Purpose of the Study:
- To evaluate the feasibility and efficacy of the pneumatic Berlin Heart ventricular assist device (VAD).
- To assess the outcomes of pediatric patients with refractory cardiogenic shock treated with the Berlin Heart VAD.
- To determine the role of the Berlin Heart VAD as a bridge to transplantation or for myocardial recovery in children.
Main Methods:
- A retrospective study involving 14 pediatric patients with severe cardiogenic shock.
- Patients were divided into a bridge-to-transplantation group (n=11) and a myocardial recovery group (n=3).
- The Berlin Heart VAD was implanted for left ventricular assist or biventricular assist.
Main Results:
- In the bridge group, 8 out of 11 patients received cardiac transplants, with 5 long-term survivors. Organ function improved in transplant recipients.
- In the recovery group, one patient experienced irreversible brain damage, one had recurrent allograft failure, and one was successfully weaned and discharged.
- Bridge durations ranged from 6 to 98 days, with a mean of 32 days.
Conclusions:
- The Berlin Heart VAD is a feasible option for selected pediatric patients with life-threatening heart failure.
- The device can sustain infants and children for weeks to months, supporting them for transplantation or myocardial recovery.
- Careful patient selection is crucial for optimizing outcomes with the Berlin Heart VAD in pediatric populations.
Objective:
The feasibility and efficacy of the pneumatic 'Berlin Heart' ventricular assist device (VAD) were evaluated in 14 pediatric patients with profound cardiogenic shock refractory to conventional therapy.
Methods:
There were two patient groups. Eleven patients, aged 2 weeks 15 years and weighing 3.2-52 kg received a left ventricular assist device or a biventricular assist device as a bridge to cardiac transplantation (bridge group). Nine of them had liver, kidney, or lung dysfunction before device implantation. Three patients were supported with a biventricular assist device for myocardial recovery (recovery group): a 6-month-old girl for postcardiotomy shock, a 10-month-old girl for allograft failure after cardiac transplantation, and a 4-year-old boy with acute myocarditis.
Results:
In the bridge group, eight patients were transplanted after a bridge duration of 6-98 days (mean, 32 days) with five long-term survivors. Organ functions were normalized during bridging in all of the transplant recipients. In the recovery group, the first patient was removed from support after 2 days because of irreversible brain damage. The second patient was weaned from biventricular support after 8 days, but suffered from recurrent allograft failure. The third patient received biventricular support for 21 days followed by extracorporeal membrane oxygenation and was subsequently discharged from the hospital.
Conclusions:
The 'Berlin Heart' VAD can keep selected infants and children with life-threatening heart failure for weeks or months.