Marijke H van der Meulen1, Michiel Dalinghaus2, Alexander P W M Maat3, Pieter C van de Woestijne3, M van Osch4, M de Hoog5, Ulrike S Kraemer5, Ad J J C Bogers3. 1. Department of Pediatric Cardiology, Erasmus Medical Center, Rotterdam, Netherlands Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands. 2. Department of Pediatric Cardiology, Erasmus Medical Center, Rotterdam, Netherlands m.dalinghaus@erasmusmc.nl. 3. Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands. 4. Department of Pediatric Cardiology, Erasmus Medical Center, Rotterdam, Netherlands. 5. Department of Pediatric Intensive Care, Erasmus Medical Center, Rotterdam, Netherlands.
Abstract
OBJECTIVES: Mechanical circulatory support (MCS) with a ventricular assist device (VAD) as a bridge to heart transplantation (HTx) or recovery may improve outcome in children with terminal heart failure. We report our experience with MCS in children eligible for HTx and its effect on waiting list mortality. METHODS: Retrospective single-centre cohort study, National Paediatric HTx Programme including all children eligible for HTx, since the introduction of MCS-VAD in 2006. RESULTS: A total of 43 patients were eligible for HTx, median age 11.7 years [Inter Quartile Range (IQR) 3.0-14.7]. In 18 patients, (42%) a VAD was implanted, 11 (61%) survived to HTx (n = 9) or recovery (n = 2). Techniques and devices used were left ventricular assist device (n = 16, 89%), in 4 cases preceded by extracorporeal membrane oxygenation (ECMO), and biventricular assist device (n = 2, 11%), both preceded by ECMO. In the VAD group, median time to death (n = 7) was 18 days (IQR 7-75), median time to HTx (n = 9) 66 days (IQR 33-223) and 2 patients recovered after 30 and 308 days. The main cause of death on MCS was neurological injury in 4 patients (22%) and systemic thrombo-embolic events in 2 (11%). The most common serious adverse events included confirmed thrombus requiring pump replacement (in 11 patients, 61%) and pericardial effusion leading to rethoracotomy (in 5 patients, 28%). Compared with the era before MCS (1998-2006), waiting list mortality decreased from 44 to 21%, and is now mainly related to complications of VAD support. CONCLUSIONS: Since the introduction of MCS-VAD, waiting list mortality halved and more children with end-stage heart failure survived to heart transplantation, thus improving outcome. Although there is substantial mortality and morbidity, overall mortality decreases, making MCS-VAD an essential therapeutic tool. The need for donor organs remains critically urgent.
OBJECTIVES: Mechanical circulatory support (MCS) with a ventricular assist device (VAD) as a bridge to heart transplantation (HTx) or recovery may improve outcome in children with terminal heart failure. We report our experience with MCS in children eligible for HTx and its effect on waiting list mortality. METHODS: Retrospective single-centre cohort study, National Paediatric HTx Programme including all children eligible for HTx, since the introduction of MCS-VAD in 2006. RESULTS: A total of 43 patients were eligible for HTx, median age 11.7 years [Inter Quartile Range (IQR) 3.0-14.7]. In 18 patients, (42%) a VAD was implanted, 11 (61%) survived to HTx (n = 9) or recovery (n = 2). Techniques and devices used were left ventricular assist device (n = 16, 89%), in 4 cases preceded by extracorporeal membrane oxygenation (ECMO), and biventricular assist device (n = 2, 11%), both preceded by ECMO. In the VAD group, median time to death (n = 7) was 18 days (IQR 7-75), median time to HTx (n = 9) 66 days (IQR 33-223) and 2 patients recovered after 30 and 308 days. The main cause of death on MCS was neurological injury in 4 patients (22%) and systemic thrombo-embolic events in 2 (11%). The most common serious adverse events included confirmed thrombus requiring pump replacement (in 11 patients, 61%) and pericardial effusion leading to rethoracotomy (in 5 patients, 28%). Compared with the era before MCS (1998-2006), waiting list mortality decreased from 44 to 21%, and is now mainly related to complications of VAD support. CONCLUSIONS: Since the introduction of MCS-VAD, waiting list mortality halved and more children with end-stage heart failure survived to heart transplantation, thus improving outcome. Although there is substantial mortality and morbidity, overall mortality decreases, making MCS-VAD an essential therapeutic tool. The need for donor organs remains critically urgent.
Authors: Amit Iyengar; Matthew L Hung; Kian Asanad; Oh Jin Kwon; Nicholas J Jackson; Brian L Reemtsen; Myke D Federman; Reshma M Biniwale Journal: Pediatr Cardiol Date: 2017-02-10 Impact factor: 1.655
Authors: Marijke van der Meulen; Susanna den Boer; Gideon J du Marchie Sarvaas; Nico Blom; Arend D J Ten Harkel; Hans M P J Breur; Lukas A J Rammeloo; Ronald Tanke; Ad J J C Bogers; Willem A Helbing; Eric Boersma; Michiel Dalinghaus Journal: ESC Heart Fail Date: 2021-02-05
Authors: Sofie Rohde; Christiaan F J Antonides; Rahatullah Muslem; Pieter C van de Woestijne; Marijke H van der Meulen; Ulrike S Kraemer; Michiel Dalinghaus; Ad J J C Bogers Journal: World J Pediatr Congenit Heart Surg Date: 2020-05