Document Detail


Pediatric bridge to heart transplantation: application of the Berlin Heart, Medos and Thoratec ventricular assist devices.
MedLine Citation:
PMID:  16399525     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Bridge to transplantation (BTT) is an accepted option when a donor heart is not available. Extensive clinical study has been done with BTT in the adult population, but comparatively fewer data are available in the pediatric population with regard to pulsatile devices. METHODS: Ten pediatric patients are presented, all of whom underwent BTT or recovery with pneumatic paracorporeal systems. The Berlin Heart bi-ventricular assist device (BVAD) was utilized in 1 patient, the Medos VAD in 4 patients (1 left ventricular assist device [LVAD], 3 BVADs) and the Thoratec VAD in 5 patients (3 BVADs, 2 LVADs). The pediatric population consisted of 3 females and 7 males. Mean age of the population was 7.4 years, weight 25 kg and body surface area (BSA) 0.88 m(2). Etiology for heart failure consisted of 4 viral, 3 congenital and 3 idiopathic cardiomyopathies. Before implant, all patients had evidence of progressive cardiac failure despite inotropic support, and 2 patients had been on extracorporeal membrane oxygenation (ECMO). Mean duration on the device was 34.3 days (8 to 107 days). RESULTS: Two patients suffered stroke and recovered without sequelae. Two patients died of ischemic stroke and 1 of sepsis. Seven patients survived (6 transplanted and 1 weaned) for a survival rate of 70% compared with survival for ECMO as BTT, which was 40% to 50%. All survivors had complications related to bleeding, thromboembolic events and infections. CONCLUSIONS: The Thoratec VAD can be placed in small patients with large hearts that can accommodate the available cannulas. The Berlin Heart and the Medos VAD have a selection of ventricles with small stroke volumes. All 3 systems can be used successfully in the pediatric population as BTT with better survival than with ECMO.
Authors:
Francisco A Arabía; Pei H Tsau; Richard G Smith; Paul E Nolan; Venki Paramesh; Raj K Bose; Daniel S Woolley; Gulshan K Sethi; Birger E Rhenman; Jack G Copeland
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Publication Detail:
Type:  Journal Article     Date:  2005-11-18
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  25     ISSN:  1557-3117     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-01-09     Completed Date:  2006-06-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  16-21     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, University of Arizona Sarver Heart Center, Tucson, Arizona 85724-5071, USA. arabiafrancisco@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Brain Ischemia / etiology
Child
Child, Preschool
Female
Heart / anatomy & histology
Heart Diseases / surgery
Heart Failure / etiology
Heart Transplantation*
Heart-Assist Devices* / adverse effects
Humans
Infant
Male
Retrospective Studies
Sepsis / etiology
Stroke / etiology
Stroke Volume
Survival Analysis
Time Factors
Waiting Lists

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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