Biventricular assist devices as a bridge to heart transplantation in small children

Experience with the use of biventricular assist device (BiVAD) support to bridge small children to heart transplantation is limited. We used BIVAD support (Berlin EXCOR) in 9 pediatric heart transplant candidates from 4/05 to 7/07. The median patient age was 1.7 years (12 days to 17 years). The medi...

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Veröffentlicht in:Circulation (New York, N.Y.) N.Y.), 2008-09, Vol.118 (14 Suppl), p.S89-S93
Hauptverfasser: Gandhi, Sanjiv K, Huddleston, Charles B, Balzer, David T, Epstein, Deirdre J, Boschert, Traci A, Canter, Charles E
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Sprache:eng
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Zusammenfassung:Experience with the use of biventricular assist device (BiVAD) support to bridge small children to heart transplantation is limited. We used BIVAD support (Berlin EXCOR) in 9 pediatric heart transplant candidates from 4/05 to 7/07. The median patient age was 1.7 years (12 days to 17 years). The median patient weight was 9.4 kg (3 to 38 kg). All children were supported with multiple intravenous inotropes+/-mechanical ventilation (6) or ECMO (3) before BiVAD implantation. All had significant right ventricular dysfunction. The median pulmonary vascular resistance index (Rpi) was 6.0 WU/m(2). Eight patients were successfully bridged to heart transplantation after a median duration of BiVAD support of 35 days (1 to 77 days). One death occurred after 10 days of support from perioperative renal failure in a 3 kg infant. Five patients required at least 1 blood pump change. One patient had a driveline infection requiring treatment. There were no acute neurological complications, no thromboembolic events, and no bleeding complications. In 2 patients with Rpi >10 WU/m(2) unresponsive to pulmonary vasodilator therapy, Rpi dropped to 1.4 and 4.6 WU/m(2), after 33 and 41 days of support, respectively. All 8 survivors underwent successful heart transplantation. Of 5 patients supported >30 days, 3 developed an extremely elevated (>90%) panel reactive antibody by ELISA that was not confirmed by other methods; none had a positive donor-specific retrospective crossmatch. There was 1 episode of rejection (with hemodynamic compromise) in the 8 transplanted patients. Rpi was normal (
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.107.754002