Characteristics of deposits and pump exchange in the Berlin Heart EXCOR ventricular assist device: Experience with 67 cases

Maeda, Keisuke; Almond, Christopher S.; Hollander, Seth A.; Rosenthal, David N.; Kaufman, Beth D.; Gowen, M.M.; Murray, Jenna; Shuttleworth, Paul; Reinhartz, Olaf

doi:10.1111/petr.13181

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…The occurrence of thrombus formation has decreased since the use of CF-VAD to 2–13% of all patients, but it occurs in 18% of pediatric patients with extracorporal pulsatile devices [ 70 ]. Pump exchange due to thrombosis is necessary for about 10% of patients who received a CF-VAD [ 74 ] and in up to 100% of pediatric patients [ 75 ]. One strategy to prevent this is to coat the surfaces that come into contact with blood with heparin or other anticoagulants which should retain their effect permanently.…”

Section: Discussionmentioning

confidence: 99%

Review and reflections about pulsatile ventricular assist devices from history to future: concerning safety and low haemolysis—still needed

Köhne

2020

J Artif Organs

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Since the first use of a ventricular assist device in 1963 many extracorporeal and implantable pulsatile blood pumps have been developed. After the invention of continuous flow blood pumps the implantable pulsatile pumps are not available anymore. The new rotary pumps spend a better quality of life because many of the patients can go home. Nevertheless, the extracorporeal pulsatile pumps have some advantages. They are low-cost systems, produce less haemolysis and heart-recovery can be tested easily. Pump failure is easy to realize because the pumps can be observed visually. Pump exchange can be done easily without any chirurgic surgery. As volume displacement pumps they can produce high blood pressure, so they are the only ones suitable for pediatric patients. Therefore, they are indispensable for clinical use today and in the future. In this work, nearly all pulsatile blood pumps used in clinical life are described.

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Section: Discussionmentioning

confidence: 99%

Review and reflections about pulsatile ventricular assist devices from history to future: concerning safety and low haemolysis—still needed

Köhne

2020

J Artif Organs

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“…Most of these pump exchanges were for pump thrombosis. Maeda et al 7 described their single center experience with EXCOR devices in 38 children. They reported 67 pump exchanges, with 82% pump exchanges for thrombosis, and higher rates of pump exchanges per month for smaller pumps and for right ventricular assist devices (RVADs) versus left ventricular assist devices (LVADs).…”

Section: Discussionmentioning

confidence: 99%

Use of bivalirudin as a primary anticoagulant in a child during Berlin Heart EXCOR ventricular assist device support

et al. 2019

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We describe our experience of bivalirudin use, a newer direct thrombin inhibitor, in an infant who was supported with Berlin Heart EXCOR VAD (Berlin VAD) as bridge to transplant for 122 days without complications and without need for pump exchange. An 11-month-old girl with dilated cardiomyopathy with acute heart failure was awaiting cardiac transplant. Lack of improvement despite maximizing medical therapy and anticipating a prolonged waitlist time, she was supported with Berlin LVAD as a bridge to transplant. Anticoagulation with bivalirudin was started and titrated with a goal partial thromboplastin time of 60-90 seconds. Therapeutic anticoagulation was achieved with bivalirudin for 50% of the days (61/122 days) on a dose of 2.1 mg/kg/hour and in a narrow dose range of 1.9 to 2.3 mg/kg/hour for 80% of the days (98/122 days). Antiplatelet regimen was started initially with aspirin and clopidogrel added later. She was supported for 122 days on a single pump without any evidence of thrombus or need for pump change. Berlin VAD explant and orthotopic heart transplant with biatrial anastomosis were performed uneventfully. Explanted Berlin VAD had no evidence of clot/fibrin or thrombus formation. The child was discharged to home uneventfully 15 days after cardiac transplant.

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“…If a free-floating thrombus of any size was detected, the pump was immediately exchanged under sterile conditions in the operating room. If the thrombus was small (<3 mm) [ 4 ], whitish and immobile (small fibrin deposits), careful observation was continued without a pump exchange and anti-coagulation therapy was adjusted.…”

Section: Methodsmentioning

confidence: 99%

Short-term outcomes of EXCOR Paediatric implantation

Komori

Hoashi

Sakaguchi

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES The aim of this study was to review a single institution’s experience with EXCOR Paediatric implantation. METHODS Patients <15 years old who underwent EXCOR implantation as a bridge to transplantation between 2015 and 2021 were enrolled. Major adverse events included death, cerebrovascular event resulting in sequelae, major infection (sepsis or surgical site infection requiring open sternal irrigation or device removal) and device malfunction requiring surgical treatment. RESULTS Overall median age and weight for all 20 children at implantation were 10.8 (interquartile range, 7.9–33.2) months and 6.3 (4.6–10.2) kg. Ten patients (50%) weighed <5 kg. Primary diagnoses were dilated cardiomyopathy in 13 patients, fulminant myocarditis in 3, restrictive cardiomyopathy in 2 and congenital heart disease in 2. Two patients required biventricular assist support. The median support time was 365 (241–636) days. Six patients (30%) were supported for >20 months. One patient died. Seven patients underwent heart transplant. Heart transplant has not been performed in the last 1.5 years. Five patients were weaned from EXCOR support after native myocardial recovery, including a patient with dilated cardiomyopathy who recovered after 24 months of EXCOR support. Major complication-free survival at 6, 12 and 18 months were 79.3%, 49.6% and 38.6%, respectively. Body weight <5 kg at implantation was a risk factor for decreased major complication-free survival. CONCLUSIONS Survival during EXCOR Paediatric support was good, but it prolonged the wait time for a heart transplant. The number of major complications increased over time and was not negligible, especially in small children.

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Characteristics of deposits and pump exchange in the Berlin Heart EXCOR ventricular assist device: Experience with 67 cases

Cited by 7 publications

References 12 publications

Review and reflections about pulsatile ventricular assist devices from history to future: concerning safety and low haemolysis—still needed

Review and reflections about pulsatile ventricular assist devices from history to future: concerning safety and low haemolysis—still needed

Use of bivalirudin as a primary anticoagulant in a child during Berlin Heart EXCOR ventricular assist device support

Short-term outcomes of EXCOR Paediatric implantation

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