Mechanical Assist Device as a Bridge to Heart Transplantation in Children Less Than 10 Kilograms

Gianluca Brancaccio, Antonio Amodeo, Zaccaria Ricci, Stefano Morelli, Maria Giulia Gagliardi, Roberta Iacobelli, Guido Michielon, Sergio Picardo, Francesco Parisi, Giacomo Pongiglione, Roberto M. Di Donato

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)58-62
Number of pages5
JournalAnnals of Thoracic Surgery
Volume90
Issue number1
DOIs
Publication statusPublished - Jul 2010

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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