Improvement in Survival After Mechanical Circulatory Support With Pneumatic Pulsatile Ventricular Assist Devices in Pediatric Patients

Role of paediatric assist device in bridge to transplant

“…They added that greater availability of smaller and potentially implantable devices for children will serve to improve these treatment strategies, while potentially improving the substantial morbidity related to anticoagulation in the smallest patients. Morales et al (34) presented the clinical outcomes for a retrospective series of 73 children supported with the Berlin Heart EXCOR as a bridge to transplantation at 17 North American centres, which is the largest single-device experience of VAD use in children reported from North America and is similar in scope to the series reported by our group (6). Their study demonstrated that the Berlin Heart EXCOR appears effective (77%) in supporting children to transplantation or recovery.…”

“…Though he was supported with an adult-sized VAD, he made it to heart transplantation ( Figure 1) (1). This successful event catalyzed the Berlin group to eventually innovate miniaturized pump systems appropriate for infants and children (2) and initiated further improvements and advances in heart failure therapy for this population (3)(4)(5)(6). The ensuing decades have seen the increased application of Berlin Heart EXCOR assist device in children in profound heart failure as a bridge to transplantation or as a bridge to myocardial recovery (7)(8)(9).…”

Diagnosis and Treatment of Myocarditis in Children in the Current Era

“…This experience is similar to recent experience in pediatric patients using adult continuous-flow VADs. 142 The overall mortality rate in patients on device in the United States during the time period of the trial was 26% with a transplantation rate of 67%, reflecting the ability of centers to use the Berlin EXCOR on a compassionate-use basis during the conduct of the trial. 144 Lower patient weight (especially <5 kg), elevated serum bilirubin, lower estimated glomerular filtration rate, and use of biventricular assist device support were associated with mortality with the device.…”

“…141 Initial experience with the use of these devices in the pediatric population is favorable, with low mortality and morbidity rates, similar to the adult experience. 142 Currently, the primary VAD used for support in children is the pulsatile Berlin Heart EXCOR, which comes in various sizes, allowing support for infants as small as 3.5 kg. Initial experience with the device in Germany was favorable, 143 and it has been available in North American for the last decade.…”

Japanese Multicenter Outcomes With the HeartMate II Left Ventricular Assist Device in Patients With Small Body Surface Area

“…Paracorporeal pneumatically powered pulsatile ventricular assist devices (VADs) have been most commonly used in small BSA patients; however, restricted mobility and higher complication rates lead to less favorable outcomes when compared with larger patients supported by continuous-flow LVADs. [4][5][6][7][8][9] To date, the largest clinical experience with the HMII has been in the USA and Europe, where the average BSA is larger than in the Japanese population. With the increased use of this device in Japan as a bridge to transplant (BTT), there is now greater experience with implantation in patients with a BSA …”