| Improvement in survival after mechanical circulatory support with pneumatic pulsatile ventricular assist devices in pediatric patients. | |
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MedLine Citation:
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PMID: 16928509 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Pediatric size pneumatically driven extracorporeal ventricular assist devices (VAD) for infants and small children were introduced into clinical routine in 1992. In the initial period, the results in infants were poor. Since then, several improvements have been introduced with regard to the cannulas, connectors, heparin coating of the blood pump inner surface, anticoagulant treatment and coagulation monitoring, and earlier decision-making in favor of pump implantation before irreversible shock has set in. METHODS: Since 1990 and as of January 1, 2005, 62 Berlin Heart Excor systems have been implanted in patients below 18 years of age at our institution. The patients were divided into two groups according to the period of treatment: period 1, devices implanted between 1990 and 1998 (n = 34), and period 2, devices implanted between 1999 and 2004 (n = 28). We compared our experience during the earlier and later periods. RESULTS: There were no significant differences in the preoperative patient data between the two periods except for time of support (17.9 +/- 27.7 days versus 53.2 +/- 83.9 days, p = 0.001). In period 1, more patients needed a biventricular VAD whereas in period 2, more patients were effectively treated with a left VAD (p = 0.05). In the later period, the chest could be primarily closed in a significantly higher percentage of infants (0% versus 89%, p = 0.012), and more infants could be extubated on the VAD (0% versus 55%, p = 0.16). Discharge from the hospital after either weaning from the system or heart transplantation was achieved for 35% in period 1 and for 68% in period 2 (p = 0.029). Whereas in period 1 there were no survivors in the group of children younger than 1 year old, during period 2, survival in this age group was similar to that of the two groups of older children (p = 0.024). There was a significant improvement in the discharge rate in period 2 in patients with cardiomyopathy (43% versus 76%, p = 0.045) and postcardiotomy heart failure (0% versus 57%, p = 0.01). CONCLUSIONS: Earlier implantation of VADs, heparin coating of the blood pumps, and substantial modifications in cannula design, anticoagulation, and the coagulation monitoring regimen have led to a significant increase in the survival and discharge rate, especially among children under 1 year of age. The pediatric size Berlin Heart Excor VAD is a valuable option as a bridge to heart transplantation or recovery for children suffering from cardiogenic shock. |
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Authors:
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Roland Hetzer; Evgenij V Potapov; Brigitte Stiller; Yuguo Weng; Michael Hübler; Julia Lemmer; Vladimir Alexi-Meskishvili; Matthias Redlin; Frank Merkle; Friedrich Kaufmann; Ewald Hennig |
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Publication Detail:
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Type: Comparative Study; Evaluation Studies; Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 82 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2006 Sep |
Date Detail:
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Created Date: 2006-08-24 Completed Date: 2006-09-13 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 917-24; discussion 924-5 Citation Subset: AIM; IM |
Affiliation:
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Deutsches Herzzentrum Berlin, Berlin, Germany. hetzer@dhzb.de |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Age Factors Anticoagulants / therapeutic use Blood Coagulation Tests Cardiomyopathies / mortality, surgery Catheterization Child Child, Preschool Equipment Design Extracorporeal Membrane Oxygenation / utilization Female Heart Transplantation Heart-Assist Devices* / adverse effects, trends Heparin / therapeutic use Humans Infant Male Pulsatile Flow Retrospective Studies Shock, Cardiogenic / mortality, surgery Stroke / epidemiology Survival Analysis Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 9005-49-6/Heparin |
| Comments/Corrections | |
Comment In:
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Ann Thorac Surg. 2006 Sep;82(3):926-32
[PMID:
16928510
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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