Samuel Weinstein1, Ricardo Bello2, Christian Pizarro3, Francis Fynn-Thompson4, James Kirklin5, Kristine Guleserian6, Ronald Woods7, Christine Tjossem8, Robert Kroslowitz8, Patricia Friedmann2, Robert Jaquiss9. 1. Cardiothoracic and Vascular Surgery, Montefiore Medical Center, New York, NY. Electronic address: sweinste@montefiore.org. 2. Cardiothoracic and Vascular Surgery, Montefiore Medical Center, New York, NY. 3. Nemours Cardiac Center, Alfred I DuPont Hospital for Children, Wilmington, Del. 4. Cardiac Surgery, Boston Childrens Hospital, Boston, Mass. 5. Cardiothoracic Surgery, University of Alabama in Birmingham, Birmingham, Ala. 6. Cardiac Surgery, Childrens Medical Center Dallas, Dallas, Tex. 7. Cardiothoracic Surgery, Childrens Hospital of Wisconsin, Milwaukee, Wis. 8. Berlin Heart Inc, The Woodlands, Tex. 9. Cardiac Surgery, Duke University Medical Center, Durham, NC.
Abstract
INTRODUCTION: The frequency and successful use of pediatric ventricular assist devices (VADs) as a bridge to cardiac transplantation have been steadily increasing since 2003, but the experience in patients with complex congenital heart disease has not been well described. Using a large prospectively collected dataset of children supported with the Berlin Heart EXCOR VAD, we have reviewed the experience in children with single ventricular anatomy or physiology (SV), and compared the results with those supported with biventricular circulation (BV) over the same time period. METHODS: The EXCOR Investigational Device Exemption study database was retrospectively reviewed. VAD implants under the primary cohort and compassionate use cohort between May 2007 and December 2011 were included in this review. RESULTS: Twenty-six of 281 patients supported with a VAD were SV. The most common diagnosis was hypoplastic left heart syndrome (15 of 26). Nine patients were supported after neonatal palliative surgery (Blalock-Taussig shunt or Sano), 12 after a superior cavopulmonary connection (SCPC), and 5 after total cavopulmonary connection (TCPC). Two patients received biventricular assist devices, 1 after stage I surgery and 1 after stage II. SV patients were supported for a median time of 10.5 days (range, 1-363 days) versus 39 days (range, 0-435 days) for BV (P = .01). The ability to be bridged to transplant or recovery in SV patients is lower than for BV patients (11 of 26 [42.3%] vs 185 of 255 [72.5%]; P = .001). Three of 5 patients with TCPC were successfully bridged to transplant and were supported with 1 VAD. Seven of 12 patients with SCPC were bridged to transplant, and only 1 of 9 patients supported after a stage I procedure survived. CONCLUSIONS: The EXCOR Pediatric VAD can provide a bridge to transplant for children with SV anatomy or physiology, albeit less successfully than in children with BV. In this small series, results are better in patients with SCPC and TCPC. VAD support for patients with shunted sources of pulmonary blood flow should be applied with caution.
INTRODUCTION: The frequency and successful use of pediatric ventricular assist devices (VADs) as a bridge to cardiac transplantation have been steadily increasing since 2003, but the experience in patients with complex congenital heart disease has not been well described. Using a large prospectively collected dataset of children supported with the Berlin Heart EXCOR VAD, we have reviewed the experience in children with single ventricular anatomy or physiology (SV), and compared the results with those supported with biventricular circulation (BV) over the same time period. METHODS: The EXCOR Investigational Device Exemption study database was retrospectively reviewed. VAD implants under the primary cohort and compassionate use cohort between May 2007 and December 2011 were included in this review. RESULTS: Twenty-six of 281 patients supported with a VAD were SV. The most common diagnosis was hypoplastic left heart syndrome (15 of 26). Nine patients were supported after neonatal palliative surgery (Blalock-Taussig shunt or Sano), 12 after a superior cavopulmonary connection (SCPC), and 5 after total cavopulmonary connection (TCPC). Two patients received biventricular assist devices, 1 after stage I surgery and 1 after stage II. SV patients were supported for a median time of 10.5 days (range, 1-363 days) versus 39 days (range, 0-435 days) for BV (P = .01). The ability to be bridged to transplant or recovery in SV patients is lower than for BV patients (11 of 26 [42.3%] vs 185 of 255 [72.5%]; P = .001). Three of 5 patients with TCPC were successfully bridged to transplant and were supported with 1 VAD. Seven of 12 patients with SCPC were bridged to transplant, and only 1 of 9 patients supported after a stage I procedure survived. CONCLUSIONS: The EXCOR Pediatric VAD can provide a bridge to transplant for children with SV anatomy or physiology, albeit less successfully than in children with BV. In this small series, results are better in patients with SCPC and TCPC. VAD support for patients with shunted sources of pulmonary blood flow should be applied with caution.
Authors: Emilie Jean-St-Michel; Devin Chetan; Steven M Schwartz; Glen S Van Arsdell; Alejandro A Floh; Osami Honjo; Jennifer Conway Journal: Pediatr Cardiol Date: 2015-09-22 Impact factor: 1.655
Authors: William T Mahle; Chenwei Hu; Felicia Trachtenberg; JonDavid Menteer; Steven J Kindel; Anne I Dipchand; Marc E Richmond; Kevin P Daly; Heather T Henderson; Kimberly Y Lin; Michael McCulloch; Ashwin K Lal; Kurt R Schumacher; Jeffrey P Jacobs; Andrew M Atz; Chet R Villa; Kristin M Burns; Jane W Newburger Journal: J Heart Lung Transplant Date: 2018-02-16 Impact factor: 10.247
Authors: David M Peng; Devin A Koehl; Ryan S Cantor; Kristen N McMillan; Aliessa P Barnes; Patrick I McConnell; Jessica Jordan; Nicholas D Andersen; James D St Louis; Katsuhide Maeda; James K Kirklin; Steven J Kindel Journal: J Heart Lung Transplant Date: 2018-10-31 Impact factor: 10.247