The Excor Device - Revival of an Old System with Excellent Results

Abstract

Objective: We report on our experience with the BerlinHeart Excor system in adults and paediatric patients who underwent placement of the mechanical support device under emergency conditions and demonstrate the exceptional advantages and the considerable versatility of the system. Methods: Since 2003, 29 consecutive patients (25 adults and 4 infants) with ages ranging from 10 months to 54 years underwent implantation of an Excor system. Main underlying heart diseases in adults were acute myocardial infarction (n = 9), dilative cardiomyopathy (n = 6), acute myocarditis (n = 6), whereas most of the children suffered from dilative cardiomyopathy. Ten patients had undergone implantation of an extracorporeal membrane oxygenation system. Results: In 26 cases, a left ventricular assist device (LVAD) was implanted, while 3 patients had biventricular support. The support interval of all patients surviving the perioperative period lasted from 30 to 412 days, mean period of support until heart transplantation or explantation was 184 ± 117 days. Severe complications were rare. Conclusion: The Excor paracorporeal mechanical support system is an excellent and highly versatile device for the support of patients of all ages and different types of underlying heart disease in the mid-term and long-term. The implant procedure and the perioperative management are simple, and complication rates are low.

Mechanical support system - heart transplantation - myocardial recovery

References

• 1 Trulock E P, Edwards L B, Taylor D O, Boucek M M, Keck B M, Hertz M I. The Registry of the International Society for Heart and Lung Transplantation: twenty-first official adult heart transplant report 2004.  J Heart Lung Transplant. 2004;  23 804-815
• 2 Wilhelm M J, Hammel D, Schmid C. et al . Partial left ventriculectomy and mitral valve repair: favorable short-term results in carefully selected patients with advanced heart failure due to dilated cardiomyopathy.  J Heart Lung Transplant. 2005;  24 1957-1964
• 3 Starling R C, Jessup M. Worldwide clinical experience with the CorCap cardiac support device.  J Card Fail. 2004;  10 S225-S233
• 4 Fauchier L, Poret P, Robin I. et al . Different criteria of cardiac resynchronization therapy and their prognostic value for worsening heart failure or major arrhythmic events in patients with idiopathic dilated cardiomyopathy.  Am J Cardiol. 2006;  97 393-399
• 5 Vitali E, Colombo T, Fratto P, Russo C, Bruschi G, Frigerio M. Surgical therapy in advanced heart failure.  Am J Cardiol. 2003;  91 88F-94F
• 6 Goldstein D J, Oz M C, Rose E A. Implantable left ventricular assist devices.  New Engl J Med. 1998;  339 1522-1533
• 7 Schmid C, Weyand M, Nabavi D G. et al . Cerebral and systemic embolization during left ventricular support with the Novacor N100 device.  Ann Thorac Surg. 1998;  65 1703-1710
• 8 Schmid C, Scheld H H, Hammel D. Control of perigraft bleeding during ventricular assist device implantation.  Ann Thorac Surg. 2000;  69 958-959
• 9 Schmid C, Wilhelm M, Rothenburger M. et al . Effect of high dose platelet inhibitor treatment on thromboembolism in Novacor patients.  Eur J Cardiothorac Surg. 2000;  17 331-335
• 10 Holman W L, Rayburn B K, McGiffin D C. et al . Infection in ventricular assist devices: prevention and treatment.  Ann Thorac Surg. 2003;  75 S48-S57
• 11 Weyand M, Kececioglu D, Kehl H. et al . Neonatal bridging to total orthotopic heart transplantation.  Ann Thorac Surg. 1998;  66 519-522
• 12 Stiller B, Hetzer R, Weng Y. et al . Heart transplantation in children after mechanical circulatory support with pulsatile pneumatic assist device.  J Heart Lung Transplant. 2003;  22 1201-1208
• 13 Riesenfeld J, Olsson P, Sanchez J, Mollnes T E. Surface modification with functionally active heparin.  Med Device Technol. 1995;  6 24-31
• 14 Scheld H H, Hammel D, Schmid C. et al . Beating heart implantation of a wearable NOVACOR left-ventricular assist device.  Thorac Cardiovasc Surgeon. 1996;  44 62-66
• 15 Schmid C, Scheld H H, Tjan T D. Biapical cannulation for biventricular support with the pneumatically driven Excor system.  ASAIO J. 2005;  51 126-127
• 16 Etz C, Welp H, Rothenburger M. et al . Analysis of platelet function during left ventricular support with the Incor and Excor system.  Heart Surg Forum. 2004;  7 E423-E427
• 17 Samuels L, Entwistle J, Holmes E. et al . Clinical use of the Abiomed BVS 5000 as a pulsatile extracorporeal membrane oxygenation unit.  ASAIO J. 2004;  50 234-236
• 18 Magliato K E, Kleisli T, Soukiasian H J. et al . Biventricular support in patients with profound cardiogenic shock: a single center experience.  ASAIO J. 2003;  49 475-479
• 19 Undar A, McKenzie E D, McGarry M C. et al . Outcomes of congenital heart surgery patients after extracorporeal life support at Texas Children's Hospital.  Artif Organs. 2004;  28 963-966
• 20 McBride L R, Naunheim K S, Fiore A C, Moroney D A, Swartz M T. Clinical experience with 111 Thoratec ventricular assist devices.  Ann Thorac Surg. 1999;  67 1233-1238 1238-1239