TY - JOUR
T1 - Mechanical Assist Device as a Bridge to Heart Transplantation in Children Less Than 10 Kilograms
AU - Brancaccio, Gianluca
AU - Amodeo, Antonio
AU - Ricci, Zaccaria
AU - Morelli, Stefano
AU - Gagliardi, Maria Giulia
AU - Iacobelli, Roberta
AU - Michielon, Guido
AU - Picardo, Sergio
AU - Parisi, Francesco
AU - Pongiglione, Giacomo
AU - Di Donato, Roberto M.
PY - 2010/7
Y1 - 2010/7
N2 - Background: Despite the remarkable advances with the use of ventricular assist devices (VAD) in adults, pneumatic pulsatile support in children is still limited. We report a retrospective review of our experience in very small children (2. Three patients required biventricular mechanical support, but in all other cases a single left VAD proved sufficient. The median duration of VAD support was 61 days (2 to 168 days). Four deaths occurred; from stroke in three and sepsis in one. Five patients were successfully bridged to heart transplantation after a median duration of mechanical support of 89 days (37 to 168 days) and another is still waiting a suitable organ after 77 days of VAD support. There were no complications related to postoperative bleeding. Five patients required at least one pump change. Of 5 patients undergoing heart transplant, 3 developed an extremely elevated (>60%) panel reactive antibody by enzyme-linked immunosorbent assay, confirmed by Luminex (Luminex Corp, Austin, TX). All 3 experienced at least one acute episode of rejection in the first month after heart transplant, needing plasmapheresis. The survival rate after heart transplantation was 100% with a median follow-up of 7.5 months. Conclusions: Mechanical support in very small children with end-stage heart failure is an effective strategy of bridge to heart transplantation with a reasonable mortality rate. The high rate of complications suggests to optimize indications and timing of VAD implantation.
AB - Background: Despite the remarkable advances with the use of ventricular assist devices (VAD) in adults, pneumatic pulsatile support in children is still limited. We report a retrospective review of our experience in very small children (2. Three patients required biventricular mechanical support, but in all other cases a single left VAD proved sufficient. The median duration of VAD support was 61 days (2 to 168 days). Four deaths occurred; from stroke in three and sepsis in one. Five patients were successfully bridged to heart transplantation after a median duration of mechanical support of 89 days (37 to 168 days) and another is still waiting a suitable organ after 77 days of VAD support. There were no complications related to postoperative bleeding. Five patients required at least one pump change. Of 5 patients undergoing heart transplant, 3 developed an extremely elevated (>60%) panel reactive antibody by enzyme-linked immunosorbent assay, confirmed by Luminex (Luminex Corp, Austin, TX). All 3 experienced at least one acute episode of rejection in the first month after heart transplant, needing plasmapheresis. The survival rate after heart transplantation was 100% with a median follow-up of 7.5 months. Conclusions: Mechanical support in very small children with end-stage heart failure is an effective strategy of bridge to heart transplantation with a reasonable mortality rate. The high rate of complications suggests to optimize indications and timing of VAD implantation.
UR - http://www.scopus.com/inward/record.url?scp=77953595993&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77953595993&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2010.03.056
DO - 10.1016/j.athoracsur.2010.03.056
M3 - Article
C2 - 20609748
AN - SCOPUS:77953595993
VL - 90
SP - 58
EP - 62
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 1
ER -