Mechanical bridging to orthotopic heart transplantation in children weighing less than 10 kg: feasibility and limitations

European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery
Ann KarimovaMichael Burch

Abstract

Infants and young children are considered the most difficult group to bridge to orthotopic heart transplantation (OHT) and data regarding outcomes are scarce. We reviewed our patients ≤ 10 kg with those who were bridged to OHT using ventricular assist device (VAD) Berlin Heart (BH) Excor ± extracorporeal membrane oxygenation (ECMO) between 2004 and 2009. Eleven children ≤ 10 kg with end-stage heart failure (cardiomyopathy or myocarditis) were treated with VAD as bridge to OHT: the median weight was 8.0 (range 3.9-10.0 kg)kg and median age was 12.3 (range 1.2-33.9 months) months. Five (45%) required ECMO support pre-BH and six were on mechanical ventilation and inotropes. In 9/11 (82%), the support mode was left ventricular assist device (L-VAD) (all alive): one of two patients needing Bi-VAD support died. On BH, the median support time was 27 days and time to extubation was 8 days. Two out of 11 (18%) suffered strokes confirmed on brain imaging; both recovered and one underwent resection of infarcted small bowel. Ten out of 11 (91%) were transplanted, one remains in hospital and nine are at home in good health. When compared to patients >10 kg bridged with BH (n = 15), the mortality (p = 0.51) and rates of neurological complica...Continue Reading

Citations

Jun 27, 2012·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Francesco SeddioPaolo Ferrazzi
Aug 28, 2013·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Thilo FleckBrigitte Stiller
Sep 28, 2012·Future Cardiology·E Siân Pincott, Michael Burch
May 20, 2014·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Oliver MieraFelix Berger
Sep 4, 2013·Current Cardiology Reports·Mazyar Kanani, Tain-Yen Hsia
Aug 15, 2014·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Aparna Hoskote, Michael Burch
Dec 28, 2018·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Oliver MieraTilman Humpl
Sep 8, 2011·Current Opinion in Critical Care·Antonis A PitsisVisouli N Aikaterini
Sep 1, 2019·Journal of Medical Case Reports·Rita GravinoGiuseppe Pacileo
Oct 31, 2019·World Journal for Pediatric & Congenital Heart Surgery·Sebastian C TumeJenna Murray
Jun 12, 2013·Annals of the New York Academy of Sciences·Charles D Fraser, Robert D B Jaquiss
Oct 21, 2020·Journal of the American Heart Association·Jennifer ConwayElfriede Pahl
Jan 9, 2021·Molecular and Cellular Biochemistry·Hana M Zegallai, Grant M Hatch
Jul 16, 2020·Heart, Lung & Circulation·Laura M DavisJohann Brink
Sep 26, 2020·Heart, Lung & Circulation·Virginie FouillouxCaroline Ovaert

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