Oliver Miera1, Matthias Germann2, My Y Cho3, Joachim Photiadis3, Eva M Delmo Walter4, Roland Hetzer5, Felix Berger6, Katharina R L Schmitt7. 1. Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. Electronic address: miera@dhzb.de. 2. Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. 3. Department of Surgery for Congenital Heart Disease/Pediatric Cardiac Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. 4. Department of Cardiothoracic, Transplantation and Vascular Surgery/Pediatric and Congenital Heart Disease Surgery, Hannover Medical School, Hannover, Germany; Cardio Centrum Berlin, Berlin, Germany. 5. Cardio Centrum Berlin, Berlin, Germany. 6. Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany; German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany; Charité‒Universitätsmedizin Berlin, Berlin, Germany. 7. Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany; German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany.
Abstract
BACKGROUND: The majority of children supported with ventricular assist devices (VADs) are bridged to heart transplantation. Although bridge to recovery has been reported, low recovery patient numbers has precluded systematic analysis. The aim of this study was to delineate recovery rates and predictors of recovery and to report on long-term follow-up after VAD explantation in children. METHODS: Children bridged to recovery at our institution from January 1990 to May 2016 were compared with a non-recovery cohort. Clinical and echocardiographic data before and at pump stoppages and after VAD explantation were analyzed. Kaplan‒Meier estimates of event-free survival, defined as freedom from death or transplantation after VAD removal, were determined. RESULTS: One hundred forty-nine children (median age 5.8 years) were identified. Of these, 65.2% had cardiomyopathy, 9.4% had myocarditis, and 24.8% had congenital heart disease. The overall recovery rate was 14.2%, and was 7.1% in patients with dilated cardiomyopathy. Predictors of recovery were age <2 years (recovery rate 27.8%, odds ratio [OR] 5.64, 95% confidence interval [CI] 2.0 to 16.6) and diagnosis of myocarditis (rate 57.1%; OR 17.56, 95% CI 4.6 to 67.4). After a median follow-up of 10.8 years, 15 patients (83.3%) were in Functional Class I and 3 (16.7%) in were in Class II. Mean left ventricular ejection fraction was 53% (range 28% to 64%). Ten- and 15-year event-free survival rates were both 84.1 ± 8.4%. CONCLUSIONS: Children <2 years of age and those diagnosed with myocarditis have the highest probability of recovery. Long-term survival after weaning from the VAD was better than after heart transplantation, as demonstrated in the excellent long-term stability of ejection fraction and functional class.
BACKGROUND: The majority of children supported with ventricular assist devices (VADs) are bridged to heart transplantation. Although bridge to recovery has been reported, low recovery patient numbers has precluded systematic analysis. The aim of this study was to delineate recovery rates and predictors of recovery and to report on long-term follow-up after VAD explantation in children. METHODS:Children bridged to recovery at our institution from January 1990 to May 2016 were compared with a non-recovery cohort. Clinical and echocardiographic data before and at pump stoppages and after VAD explantation were analyzed. Kaplan‒Meier estimates of event-free survival, defined as freedom from death or transplantation after VAD removal, were determined. RESULTS: One hundred forty-nine children (median age 5.8 years) were identified. Of these, 65.2% had cardiomyopathy, 9.4% had myocarditis, and 24.8% had congenital heart disease. The overall recovery rate was 14.2%, and was 7.1% in patients with dilated cardiomyopathy. Predictors of recovery were age <2 years (recovery rate 27.8%, odds ratio [OR] 5.64, 95% confidence interval [CI] 2.0 to 16.6) and diagnosis of myocarditis (rate 57.1%; OR 17.56, 95% CI 4.6 to 67.4). After a median follow-up of 10.8 years, 15 patients (83.3%) were in Functional Class I and 3 (16.7%) in were in Class II. Mean left ventricular ejection fraction was 53% (range 28% to 64%). Ten- and 15-year event-free survival rates were both 84.1 ± 8.4%. CONCLUSIONS:Children <2 years of age and those diagnosed with myocarditis have the highest probability of recovery. Long-term survival after weaning from the VAD was better than after heart transplantation, as demonstrated in the excellent long-term stability of ejection fraction and functional class.
Authors: Eva Maria Javier Delmo; Mariano Francisco Del Maria Javier; Dietmar Böthig; Andre Rüffer; Robert Cesnjevar; Michael Dandel; Roland Hetzer Journal: Cardiovasc Diagn Ther Date: 2021-02
Authors: Jirko Kühnisch; Sabine Klaassen; Franziska Seidel; Manuel Holtgrewe; Nadya Al-Wakeel-Marquard; Bernd Opgen-Rhein; Josephine Dartsch; Christopher Herbst; Dieter Beule; Thomas Pickardt; Karin Klingel; Daniel Messroghli; Felix Berger; Stephan Schubert Journal: Circ Genom Precis Med Date: 2021-07-02