Thorac Cardiovasc Surg 2019; 67(S 02): S101-S128
DOI: 10.1055/s-0039-1679048
Oral Presentations
Sunday, February 17, 2019
Kinderkardiologische/Kinderkardiochirugische Intensivmedizin
Georg Thieme Verlag KG Stuttgart · New York

Illuminating Risk Factors for Berlin Heart EXCOR Device Support in Children with Congenital Heart Disease: Lessons Learned!

J. Völkner
1   Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
,
L. K. R. Schmitt
1   Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
,
C. Pfitzer
1   Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
2   Berlin Institute of Health (BIH), Berlin, Germany
,
F. Berger
1   Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
3   Department of Pediatric Cardiology, Charité Universitätsmedizin Medizin, Berlin, Germany
,
J. Photiadis
4   Department of Congenital Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
,
O. Miera
1   Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
2   Berlin Institute of Health (BIH), Berlin, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
28 January 2019 (online)

 
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    Introduction: The implantation of ventricular assist devices (VADs) in children suffering from terminal heart failure has increased over the past years. However, in current studies on this cohort, children with congenital heart disease (CHD) remain underrepresented, resulting in little knowledge about risk factors or the optimal timing of device implantation for this cohort. Therefore, we conducted a retrospective study to present data on our 27-year experience of VAD therapy in CHD patients.

    Methods: This retrospective, monocentric study involved all CHD patients implanted with a VAD between January 1, 1990, and February 27, 2017 (n = 37). We examined the clinical status before device implantation as well as the outcome (death, successful transplantation, weaning, or still on assist). Patients were divided into two groups depending on the time of device implantation (before or after 2000).

    Results: Of our cohort, 22 (59.5%) patients died, 9 (24.3%) patients received successful transplantation, 5 (13.5%) patients could be weaned, and 1 (2.7%) patient was still on assist at the end of the study. Maximum support time was 842 days (median: 15 ± 169 days). Early mortality (within 30 days) was high as 72.7% of all deaths occurred in this period. Factors associated, also with overall mortality, were univentricular physiology, a high inotrope dependency, low median arterial pressure, high FiO2, low PaO2, age < 30 days, and a small body surface were associated with an increased overall or early mortality. ECMO therapy before device implantation was significantly longer in patients who survived VAD therapy (p = 0.028). Early mortality was significantly lower in patients who were treated in the later period (p = 0.014), whereas support time was significantly higher (p = 0.019).

    Conclusion: VAD implantation can offer long-term support as a bridge to transplant therapy for CHD patients. However, patient selection is essential to guarantee successful VAD therapy with special attention to age, CHD phenotype, inotropic dependency, and status of ventilation therapy. ECMO therapy can increase therapy success when used to stabilize organ function before device implantation.


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    No conflict of interest has been declared by the author(s).

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