Single-center experience with treatment of cardiogenic shock in children by pediatric ventricular assist devices

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 141; no. 3; pp. 616 - 623.e1
• Main Authors: Hetzer, Roland, MD, PhD, Potapov, Evgenij V., MD, PhD, Alexi-Meskishvili, Vladimir, MD, PhD, Weng, Yuguo, MD, PhD, Miera, Oliver, MD, Berger, Felix, MD, PhD, Hennig, Ewald, PhD, Hübler, Michael, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-03-2011; Elsevier
• Subjects: Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants - therapeutic use; Bilirubin - blood; Biological and medical sciences; Biomarkers - blood; Cardiology. Vascular system; Cardiothoracic Surgery; Chi-Square Distribution; Child; Child, Preschool; Creatinine - blood; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Germany; Heart Transplantation; Heart-Assist Devices - adverse effects; Hospital Mortality; Humans; Infant; Infant, Newborn; Intensive care medicine; Male; Medical sciences; Patient Discharge; Pneumology; Prosthesis Design; Respiration, Artificial; Retrospective Studies; Shock, Cardiogenic - blood; Shock, Cardiogenic - mortality; Shock, Cardiogenic - surgery; Shock, Cardiogenic - therapy; Survival Rate; Thrombosis - etiology; Thrombosis - prevention & control; Time Factors; Treatment Outcome; Germany; ECMO; 34; biventricular assist device; 27; BNP; BVAD; LVAD; ventricular assist device; B-type natriuretic peptide; VAD; extracorporeal membrane oxygenation; left ventricular assist device; 20; Human; Artificial heart; Intensive cardiocirculatory care; Pediatrics; Center; Artificial ventricle; Cardiocirculatory support; Cardiovascular disease; Experience; Treatment; Heart disease; Cardiogenic shock; Auxiliary ventricule; Anesthesia; Circulatory system; Cardiology; Child
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2010.06.066

Background Pediatric ventricular assist devices may be superior to extracorporeal membrane oxygenation in some respects, especially for medium- and long-term cardiac support. We present our nearly 20-year experience with pediatric ventricular assist devices. Methods Between 1990 and April 2009, Berlin Heart EXCOR (Berlin Heart AG, Berlin, Germany) was implanted in 94 children. Patients were compared according to period of treatment: group I, implantation between 1990 and 2001 (n = 45), and group II, implantation since 2002 (n = 49). Results Preoperative serum creatinine (1.2 vs 0.7 mg/dL, P  = .002) and bilirubin (1.5 vs 1 mg/dL, P  = .002) were lower in period II, and fewer patients were artificially ventilated before surgery (26 vs 13, P  = .002). In period I, more patients were supported with biventricular assist devices (64% vs 22.5%, P  < .001). Median time on support was shorter in period I (10 vs 40 days, P  < .001). Success (weaning from system or heart transplant) was achieved in 49% and 69%, respectively ( P  = .043). Whereas in period I 17% of children younger than 1 year were discharged home after transplant or weaning, rate during period II was 93% ( P  < .001), in particular because of improvement in discharge rate of patients with postcardiotomy heart failure (13% vs 50%). Rates of pump exchange for thrombus formation were 0.029/d in period I and 0.014/d in period II ( P  = 0.003). Conclusions Recent results show significant improvements in survival and discharge rate, especially for children younger than 1 year. Pediatric Berlin Heart EXCOR ventricular assist device may provide a safe mechanical support strategy in children with cardiogenic shock.