The Use of Berlin Heart EXCOR VAD in Children Less than 10 kg

A Single Center Experience

Arianna Di Molfetta, Fabrizio Gandolfo, Sergio Filippelli, Gianluigi Perri, Luca Di Chiara, Roberta Iacobelli, Rachele Adorisio, Isabella Favia, Alessandra Rizza, Giuseppina Testa, Matteo Di Nardo, Antonio Amodeo

Research output: Contribution to journalArticle

Abstract

Objective: Despite the improvement in ventricular assist device (VAD) therapy in adults and in adolescents, in infant population only Berlin Heart EXCOR (BHE) is licensed as long term VAD to bridge children to Heart Transplantation (HTx). Particularly demanding in terms of morbidity and mortality are smallest patients namely the ones implanted in the first year of life or with a lower body surface area. This work aims at retrospective reviewing a single center experience in using BHE in children with a body weight under 10 kg. Methods: Data of all pediatric patients under 10 kg undergoing BHE implantation in our institution from March 2002 to March 2016 were retrospectively reviewed. Results: Of the 30 patients enrolled in the study, 53% were male, 87% were affected by a dilated cardiomyopathy with an average weight and age at the implantation of 6.75 ± 2.16 Kg and 11.57 ± 10.12 months, respectively. Three patients (10%) required a BIVAD implantation. After the implantation, 7 patients (23%) required re-intervention for bleeding and 9 patients (30%) experienced BHE cannulas infection. A total of 56 BHE pump were changed for thrombus formation (1.86 BHE pump for patient). The average duration of VAD support was 132.8 ± 94.4 days. Twenty patients (67%) were successfully transplanted and 10 patients (33%) died: 7 for major neurological complication and 3 for sepsis. Conclusion: Mechanical support in smaller children with end stage heart failure is an effective strategy for bridging patients to HTx. The need for BIVAD was relegated, in the last years, only to restrictive cardiomiopathy. Further efforts are required in small infants to improve anticoagulation strategy to reduce neurological events and BHE pump changes.

Original languageEnglish
Pages (from-to)614
JournalFrontiers in Physiology
Volume7
DOIs
Publication statusPublished - 2016

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Heart-Assist Devices
Berlin
Body Surface Area
Dilated Cardiomyopathy
Heart Transplantation
Sepsis
Thrombosis
Heart Failure
Body Weight
Pediatrics
Hemorrhage
Morbidity
Weights and Measures

Keywords

  • Journal Article

Cite this

The Use of Berlin Heart EXCOR VAD in Children Less than 10 kg : A Single Center Experience. / Di Molfetta, Arianna; Gandolfo, Fabrizio; Filippelli, Sergio; Perri, Gianluigi; Chiara, Luca Di; Iacobelli, Roberta; Adorisio, Rachele; Favia, Isabella; Rizza, Alessandra; Testa, Giuseppina; Di Nardo, Matteo; Amodeo, Antonio.

In: Frontiers in Physiology, Vol. 7, 2016, p. 614.

Research output: Contribution to journalArticle

Di Molfetta, Arianna ; Gandolfo, Fabrizio ; Filippelli, Sergio ; Perri, Gianluigi ; Chiara, Luca Di ; Iacobelli, Roberta ; Adorisio, Rachele ; Favia, Isabella ; Rizza, Alessandra ; Testa, Giuseppina ; Di Nardo, Matteo ; Amodeo, Antonio. / The Use of Berlin Heart EXCOR VAD in Children Less than 10 kg : A Single Center Experience. In: Frontiers in Physiology. 2016 ; Vol. 7. pp. 614.
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abstract = "Objective: Despite the improvement in ventricular assist device (VAD) therapy in adults and in adolescents, in infant population only Berlin Heart EXCOR (BHE) is licensed as long term VAD to bridge children to Heart Transplantation (HTx). Particularly demanding in terms of morbidity and mortality are smallest patients namely the ones implanted in the first year of life or with a lower body surface area. This work aims at retrospective reviewing a single center experience in using BHE in children with a body weight under 10 kg. Methods: Data of all pediatric patients under 10 kg undergoing BHE implantation in our institution from March 2002 to March 2016 were retrospectively reviewed. Results: Of the 30 patients enrolled in the study, 53{\%} were male, 87{\%} were affected by a dilated cardiomyopathy with an average weight and age at the implantation of 6.75 ± 2.16 Kg and 11.57 ± 10.12 months, respectively. Three patients (10{\%}) required a BIVAD implantation. After the implantation, 7 patients (23{\%}) required re-intervention for bleeding and 9 patients (30{\%}) experienced BHE cannulas infection. A total of 56 BHE pump were changed for thrombus formation (1.86 BHE pump for patient). The average duration of VAD support was 132.8 ± 94.4 days. Twenty patients (67{\%}) were successfully transplanted and 10 patients (33{\%}) died: 7 for major neurological complication and 3 for sepsis. Conclusion: Mechanical support in smaller children with end stage heart failure is an effective strategy for bridging patients to HTx. The need for BIVAD was relegated, in the last years, only to restrictive cardiomiopathy. Further efforts are required in small infants to improve anticoagulation strategy to reduce neurological events and BHE pump changes.",
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T1 - The Use of Berlin Heart EXCOR VAD in Children Less than 10 kg

T2 - A Single Center Experience

AU - Di Molfetta, Arianna

AU - Gandolfo, Fabrizio

AU - Filippelli, Sergio

AU - Perri, Gianluigi

AU - Chiara, Luca Di

AU - Iacobelli, Roberta

AU - Adorisio, Rachele

AU - Favia, Isabella

AU - Rizza, Alessandra

AU - Testa, Giuseppina

AU - Di Nardo, Matteo

AU - Amodeo, Antonio

PY - 2016

Y1 - 2016

N2 - Objective: Despite the improvement in ventricular assist device (VAD) therapy in adults and in adolescents, in infant population only Berlin Heart EXCOR (BHE) is licensed as long term VAD to bridge children to Heart Transplantation (HTx). Particularly demanding in terms of morbidity and mortality are smallest patients namely the ones implanted in the first year of life or with a lower body surface area. This work aims at retrospective reviewing a single center experience in using BHE in children with a body weight under 10 kg. Methods: Data of all pediatric patients under 10 kg undergoing BHE implantation in our institution from March 2002 to March 2016 were retrospectively reviewed. Results: Of the 30 patients enrolled in the study, 53% were male, 87% were affected by a dilated cardiomyopathy with an average weight and age at the implantation of 6.75 ± 2.16 Kg and 11.57 ± 10.12 months, respectively. Three patients (10%) required a BIVAD implantation. After the implantation, 7 patients (23%) required re-intervention for bleeding and 9 patients (30%) experienced BHE cannulas infection. A total of 56 BHE pump were changed for thrombus formation (1.86 BHE pump for patient). The average duration of VAD support was 132.8 ± 94.4 days. Twenty patients (67%) were successfully transplanted and 10 patients (33%) died: 7 for major neurological complication and 3 for sepsis. Conclusion: Mechanical support in smaller children with end stage heart failure is an effective strategy for bridging patients to HTx. The need for BIVAD was relegated, in the last years, only to restrictive cardiomiopathy. Further efforts are required in small infants to improve anticoagulation strategy to reduce neurological events and BHE pump changes.

AB - Objective: Despite the improvement in ventricular assist device (VAD) therapy in adults and in adolescents, in infant population only Berlin Heart EXCOR (BHE) is licensed as long term VAD to bridge children to Heart Transplantation (HTx). Particularly demanding in terms of morbidity and mortality are smallest patients namely the ones implanted in the first year of life or with a lower body surface area. This work aims at retrospective reviewing a single center experience in using BHE in children with a body weight under 10 kg. Methods: Data of all pediatric patients under 10 kg undergoing BHE implantation in our institution from March 2002 to March 2016 were retrospectively reviewed. Results: Of the 30 patients enrolled in the study, 53% were male, 87% were affected by a dilated cardiomyopathy with an average weight and age at the implantation of 6.75 ± 2.16 Kg and 11.57 ± 10.12 months, respectively. Three patients (10%) required a BIVAD implantation. After the implantation, 7 patients (23%) required re-intervention for bleeding and 9 patients (30%) experienced BHE cannulas infection. A total of 56 BHE pump were changed for thrombus formation (1.86 BHE pump for patient). The average duration of VAD support was 132.8 ± 94.4 days. Twenty patients (67%) were successfully transplanted and 10 patients (33%) died: 7 for major neurological complication and 3 for sepsis. Conclusion: Mechanical support in smaller children with end stage heart failure is an effective strategy for bridging patients to HTx. The need for BIVAD was relegated, in the last years, only to restrictive cardiomiopathy. Further efforts are required in small infants to improve anticoagulation strategy to reduce neurological events and BHE pump changes.

KW - Journal Article

U2 - 10.3389/fphys.2016.00614

DO - 10.3389/fphys.2016.00614

M3 - Article

VL - 7

SP - 614

JO - Frontiers in Physiology

JF - Frontiers in Physiology

SN - 1664-042X

ER -