Bridging children of all sizes to cardiac transplantation: The initial multicenter North American experience with the Berlin Heart EXCOR ventricular assist device

被引：194

作者：

Morales, David L. S. ^{[1
]}

Almond, Christopher S. D. ^{[2
]}

Jaquiss, Robert D. B. ^{[3
]}

Rosenthal, David N. ^{[4
,5
]}

Naftel, David C. ^{[6
]}

Massicotte, M. Patricia ^{[7
]}

Humpl, Tilman ^{[8
]}

Turrentine, Mark W. ^{[9
]}

Tweddell, James S. ^{[10
]}

Cohen, Gordon A. ^{[11
]}

Kroslowitz, Robert ^{[12
]}

Devaney, Eric J. ^{[13
]}

Canter, Charles E. ^{[14
]}

Fynn-Thompson, Francis ^{[15
]}

Reinhartz, Olaf ^{[16
]}

Imamura, Michiaki ^{[3
]}

Ghanayem, Nancy S. ^{[17
]}

Buchholz, Holger ^{[18
]}

Furness, Sarah ^{[19
]}

Mazor, Robert ^{[20
]}

Gandhi, Sanjiv K. ^{[21
]}

Fraser, Charles D., Jr. ^{[1
]}

机构：

[1] Texas Childrens Hosp, Div Congenital Heart Surg, Baylor Coll Med, Michael E DeBakey Dept Surg, Houston, TX 77030 USA

[2] Harvard Univ, Sch Med, Dept Pediat, Dept Cardiol,Childrens Hosp Boston, Boston, MA 02115 USA

[3] Univ Arkansas Med Sci, Dept Surg, Arkansas Childrens Hosp, Congenital Thorac Surg Div, Little Rock, AR 72205 USA

[4] Stanford Univ, Div Pediat Cardiol, Stanford, CA 94305 USA

[5] Lucile Packard Childrens Hosp, Palo Alto, CA USA

[6] Univ Alabama Birmingham, Dept Surg, Birmingham, AL 35294 USA

[7] Univ Alberta, Dept Pediat, Stollery Childrens Hosp, Edmonton, AB, Canada

[8] Univ Toronto, Hosp Sick Children, Div Cardiac Crit Care, Dept Paediat,Div Cardiol,Dept Crit Care Med, Toronto, ON M5G 1X8, Canada

[9] Indiana Univ Sch Med, Dept Surg, Riley Hosp Children, Pediat Cardiovasc Surg Div, Indianapolis, IN USA

[10] Med Coll Wisconsin, Childrens Hosp Wisconsin, Milwaukee, WI 53226 USA

[11] Univ Washington, Sch Med, Seattle Childrens Hosp, Pediat Cardiothorac Surg Div, Seattle, WA USA

[12] Berlin Heart Inc, The Woodlands, TX USA

[13] Univ Michigan, Sch Med, Dept Surg, Pediat Cardiovasc Surg Div,CS Mott Childrens Hosp, Ann Arbor, MI USA

[14] Washington Univ, St Louis Childrens Hosp, Dept Pediat Cardiol, Sch Med, St Louis, MO 63110 USA

[15] Harvard Univ, Sch Med, Childrens Hosp Boston, Dept Cardiac Surg, Boston, MA USA

[16] Stanford Univ, Med Ctr, Dept Cardiothorac Surg, Pediat Cardiac Surg Div, Stanford, CA 94305 USA

[17] Med Coll Wisconsin, Childrens Hosp Wisconsin, Dept Pediat, Pediat Intens Care Unit, Milwaukee, WI 53226 USA

[18] Univ Alberta, Dept Surg, Stollety Childrens Hosp, Cardiac Surg Div, Edmonton, AB, Canada

[19] Hosp Sick Children, Div Cardiac Crit Care, Dept Crit Care Med, Toronto, ON M5G 1X8, Canada

[20] Univ Washington, Sch Med, Dept Pediat, Crit Care Med Div,Seattle Childrens Hosp, Seattle, WA 98195 USA

[21] Washington Univ, Sch Med, Dept Surg, Cardiothorac Surg Div,St Louis Childrens Hosp, St Louis, MO 63110 USA

来源：

JOURNAL OF HEART AND LUNG TRANSPLANTATION | 2011年 / 30卷 / 01期

关键词：

heart-assist device; extracorporeal circulation; transplantation; pediatrics; EXTRACORPOREAL MEMBRANE-OXYGENATION; SUPPORT; ECMO;

D O I：

10.1016/j.healun.2010.08.033

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Beginning in 2000 and accelerating in 2004, the Berlin Heart EXCOR (Berlin Heart Inc Woodlands, TX) became the first pediatric-specific ventricular assist device (VAD) applied throughout North America for children of all sizes. This retrospective study analyzed the initial Berlin Heart EXCOR pediatric experience as a bridge to transplantation. METHODS: Between June 2000 and May 2007, 97 EXCOR VADs were implanted in North America at 29 different institutions. The analysis is limited to 73 patients (75%) from 17 institutions, for which retrospective data were available. RESULTS: Median age and weight at VAD implant were 2.1 years (range, 12 days-17.8 years) and 11 kg (range, 3-87.6 kg), respectively. The primary diagnoses were dilated cardiomyopathy in 42 (58%), congenital heart disease in 19 (26%), myocarditis in 7(10%), and other cardiomyopathies in 5 (7%). Pre-implant clinical condition was critical cardiogenic shock in 38 (52%), progressive decline in 33 (45%), or other in 2 (3%). Extracorporeal membrane oxygenation was used as a bridge to EXCOR in 22 patients (30%). Device selection was left VAD (LVAD) in 42 (57%) and biventricular assist devices (BiVAD) in 31(43%). The EXCOR bridged 51 patients (70%) to transplant and 5 (7%) to recovery. Mortality on the EXCOR was 23% (n = 17) overall, including 35% (11 of 31) in BiVAD vs 14% (6 of 42) in LVAD patients (p = 0.003). Multivariate analysis showed younger age and BiVAD support were significant risk factors for death while on the EXCOR. CONCLUSIONS: This limited but large preliminary North American experience with the Berlin Heart EXCOR VAD as a bridge to cardiac transplantation for children of all ages and sizes points to the feasibility of this approach. The prospective investigational device evaluation trial presently underway will further characterize the safety and efficacy of the EXCOR as a bridge to pediatric cardiac transplantation. J Heart Lung Transplant 2011;30:1-8 (C) 2011 International Society for Heart and Lung Transplantation. All rights reserved.

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页码：1 / 8

页数：8

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