First Polish analysis of the treatment of advanced heart failure in children with the use of BerlinHeart EXCOR mechanical circulatory support

Pawlak, Szymon; Przybylski, Roman; Skalski, Janusz; Śliwka, Joanna; Kansy, Andrzej; Grzybowski, Adam; Wierzyk, Arkadiusz; Białkowski, Jacek; Maruszewski, Bohdan; Zembala, Marian

doi:10.5603/kp.a2017.0201

Cited by 5 publications

(2 citation statements)

References 10 publications

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“…There were 41 857 articles identified with the search strategy, of which 14 3,5,9,[22][23][24][25][26][27][28][29][30][31][32] were kept in the final review (Figure 1). Within these studies, with data ranging from 1990 to 2020, 58 hospitals in North America, Europe, Australia, and Asia supported 984 children with BHE (Table 1).…”

Section: Overall Study Populationmentioning

confidence: 99%

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Successful explantation of children from the Berlin Heart EXCOR® ventricular assist device: A systematic review

Mikulski,

Iyer,

Well

et al. 2024

Artificial Organs

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BackgroundThe Berlin Heart EXCOR® (BHE) can bridge children with severe heart failure to transplantation, but some are successfully weaned and spared transplantation. This study seeks to identify characteristics of children amenable to successful explantation with BHE support.MethodsPreferred Reporting Items for Systematic reviews and Meta‐Analyses 2020 guidelines were used. Five databases were screened for original, English articles measuring BHE support in patients <18 years old based on title and abstract. Exclusion criteria were applied: full‐text availability, <10 total pediatric BHE patients, zero successful explantations from BHE, nonprimary literature, adult and pediatric results that could not be separated, and studies with overlapping patient information. Studies were analyzed with descriptive statistics.ResultsFrom 41 857 potential studies, 14 were analyzed with data from 58 hospitals on four continents from 1990 to 2020. There were 984 BHE patients. The most common diagnosis was dilated cardiomyopathy (n = 318, 32.3%), followed by congenital heart disease (n = 249, 25.3%). There were 85 (8.6%) children explanted with favorable outcomes. The underlying diagnosis was known in 44 (51.8%) cases: 14 (8.4%) of 166 cardiomyopathies, 17 (48.6%) of 35 myocarditis, and 12 (16.7%) of 72 with congenital heart disease were explanted. When the type of support was known, the rate of LVAD patients explanted was 21.3% (n = 19/89) and 2.4% (n = 1/42) of BiVAD patients were explanted.ConclusionExplantation from BHE is not uncommon at 8.6%, but significant variation exists in the explantation data reported. Myocarditis and LVAD support may be populations suitable for weaning. Standardization of reporting measures and prospective registries may help identify patients suitable for this alternative to transplant and help develop weaning protocols.

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Section: Overall Study Populationmentioning

confidence: 99%

“…Of the 14 studies, 4 (29%) described a weaning protocol or explantation process (Table 4). 22,[26][27][28] Three studies described specific parameters for weaning. The physical explantation procedure was described in just one study and occurred in the operating room.…”

Section: Weaning Protocolsmentioning

confidence: 99%

Successful explantation of children from the Berlin Heart EXCOR® ventricular assist device: A systematic review

Mikulski,

Iyer,

Well

et al. 2024

Artificial Organs

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Myocardial recovery in children supported with a durable ventricular assist device—a systematic review

Rohde

Bogers

et al. 2023

European Journal of Cardio-Thoracic Surgery

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Introduction A small percentage of paediatric patients supported with a ventricular assist device (VAD) can have their device explanted following myocardial recovery. The aim of this systematic review is to summarize current literature on clinical course in these children after weaning. Methods A systematic literature search was performed on 27th of May, 2022 using Embase, Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar to include all literature on paediatric patients supported by a durable VAD of the last decade. Overlapping study cohorts and registry-based studies were filtered out. Results Thirty-seven articles were included. Eighteen of them reported on incidence of recovery in cohort studies, with an overall incidence rate of 8.7% (81/928). Twenty-two of the included articles reported on clinical outcomes after VAD explantation (83 patients). Aetiology varied widely and was not limited to diseases with a natural transient course like myocarditis. Most of the patients in the included studies (70; 84.3%) were supported by a Berlin Heart EXCOR™, and in 66.3% (55/83) only the left ventricle had to be supported. The longest follow-up was 19.1 years and multiple studies reported on long-term myocardial recovery. Less than half of the reported deaths had a cardiac cause. Conclusions Myocardial recovery during VAD support is dependent on various contributing components. The interaction between patient-, device-, time-, and hospital-related factors is complex and not yet fully understood. Long-term recovery after VAD support is achievable, even after a long duration of VAD support, and even in patients with aetiology different than myocarditis or post-cardiotomy heart failure. More research is needed on this favourable outcome after VAD support.

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Clinical outcomes of paediatric patients supported by the Berlin Heart EXCOR: a systematic review

Rohde

Antonides

Dalinghaus³

et al. 2019

European Journal of Cardio-Thoracic Surgery

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Summary Ventricular assist devices (VADs) are widely accepted as therapy to bridge children to heart transplantation. We provide a systematic review of the current state of clinical outcomes in children after paediatric VAD support by the Berlin Heart EXCOR (BH EXCOR) device. A systematic literature search was performed in April 2018. Studies reporting clinical outcomes in at least 15 children supported by a BH EXCOR VAD were included. Additionally, we focused on outcomes in small children and compared outcomes of children supported by a left ventricular assist device (LVAD) versus children supported by a biventricular assist device (BiVAD). Eighteen publications fulfilled the inclusion criteria and were included in this systematic review. Mortality rates ranged from 6.3% [confidence interval (CI) 0.0–18.1%] to 38.9% (2.8–75.0%) while transplantation rates ranged from 37.0% (CI 18.8–55.2%) to 72.5% (CI 63.9–81.2%) and successful weaning rates from 0.0% to 20.7% (CI 6.0–35.5%). In children under 1 year of age, mortality rates ranged from 20.0% to 55.5% and transplantation rates ranged from 0.0% to 62.5%. BiVAD support seemed to result in worse clinical outcomes than LVAD support. Incidence of stroke ranged from 5.0% to 47.0% in all children supported with the BH EXCOR. Although a high incidence of adverse events such as stroke and pump thrombosis is reported, VAD support should be considered in children with end-stage heart failure awaiting heart transplantation. Further research is warranted, especially on optimal timing of device implantation and anticoagulation regimens.

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First Polish analysis of the treatment of advanced heart failure in children with the use of BerlinHeart EXCOR mechanical circulatory support

Cited by 5 publications

References 10 publications

Successful explantation of children from the Berlin Heart EXCOR® ventricular assist device: A systematic review

Successful explantation of children from the Berlin Heart EXCOR® ventricular assist device: A systematic review

Myocardial recovery in children supported with a durable ventricular assist device—a systematic review

Clinical outcomes of paediatric patients supported by the Berlin Heart EXCOR: a systematic review

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