Mechanical Circulatory Support in Infants and Adults With the MEDOS/HIA Assist Device

Kaczmarek, Ingo; Mair, Helmut; Groetzner, J; Sachweh, Joerg S.; Oberhoffer, Martin; Fuchs, Alain H.; Reichart, Bruno; Daebritz, Sabine

doi:10.1111/j.1525-1594.2005.00140.x

Cited by 14 publications

(8 citation statements)

References 11 publications

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“…20,21 There is one published pediatric series that used the MEDOS/HIA device (MEDOS Medizintechnik AG, Stolberg, Germany) and reported less favorable results (2 of 13 patients died during implantation; of the remaining 11 children, five died during support after 2-38 days). 22 MCS is a serious burden for children and their families. Hospitalization and loss of mobility are severe problems, at least in toddlers and young schoolchildren.…”

Section: Discussionmentioning

confidence: 99%

The Pediatric Mechanical Circulatory Support Program in Innsbruck, Austria, and the Impact of Such Programs on Lack of Donor Hearts in Europe

Schweigmann

Antretter²,

Mair³

et al. 2007

ASAIO Journal

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Strategy and results of the Innsbruck Mechanical Circulatory Support Program are presented, and the impact of such programs on pediatric heart transplantation (HTX) in Europe is discussed. Venoarterial extracorporeal membrane oxygenation (vaECMO) and ventricular assist devices (VADs) were used in 21 pediatric patients (median age 3.3 years, 2 days to 17 years) for acute heart failure (AHF) following a bridge or bridge-to-bridge strategy. Twelve patients were treated with vaECMO: eight were weaned after 2-10 days, two died, and two were switched to a VAD. Of the last, one was weaned 47 days later and the other underwent HTX 168 days later. In nine patients, VAD was implanted without preceding vaECMO. One such patient died (cerebral hemorrhage) after 236 days; of the remaining eight patients three were weaned and five underwent HTX. Waiting time for HTX (high-urgency status) varied from 4 to 372 days. Fifteen patients were discharged (follow up: 2-74 months); 14 are doing very well (New York Heart Association (NYHA) Functional Classification Class I, neurologically normal), whereas one suffers from severe neurologic damage, presumably from resuscitation before vaECMO. Data from Eurotransplant on pediatric HTX in 2004, 2005, and 2006 (33, 49, and 34 transplanted hearts, respectively; recipients <16 years of age) are discussed. Mechanical circulatory support (MCS) substantially improves survival with AHF in pediatric patients. Medium-term support (up to 400 days in our patients) is possible and outcome of survivors is excellent. Wide spread use of MCS might slightly aggravate the lack of donor organs, which could result in longer support times.

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Section: Discussionmentioning

confidence: 99%

The Pediatric Mechanical Circulatory Support Program in Innsbruck, Austria, and the Impact of Such Programs on Lack of Donor Hearts in Europe

Schweigmann

Antretter²,

Mair³

et al. 2007

ASAIO Journal

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“…[13][14][15][16][17] The utility of shortterm devices, such the Medos, 18 Abiomed and Impella, has been shown in primary graft failure and post-cardiotomy, but the first 2 of these devices have significant risks of thromboembolism, bleeding and infection, raising the clinical cost. Moreover, the Abiomed BVS 500, the most widely used in this category, still has several limitations, including: pump-related complications (seal disruption); the patient's continued sedation and inability to ambulate; and a maximum achievable flow of 6 liters, which is sometimes not sufficient in septic patients.…”

Section: Discussionmentioning

confidence: 99%

Levitronix as a Short-term Salvage Treatment for Primary Graft Failure After Heart Transplantation

Santise

Petrou

Pepper

et al. 2006

The Journal of Heart and Lung Transplantation

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“…81 Similar to most first generation devices, flow paths through the device appear sub-optimal which commonly leads to thrombus formation in the outflow tracts of both LVADs and RVADs. 28 Meanwhile, the large drive system again confines patients to hospital while receiving VAD support, which severely limits their quality of life.…”

Section: Medos Hia-vadmentioning

confidence: 99%

Biventricular Assist Devices: A Technical Review

et al. 2011

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The optimal treatment option for end stage heart failure is transplantation; however, the shortage of donor organs necessitates alternative treatment strategies such as mechanical circulatory assistance. Ventricular assist devices (VADs) are employed to support these cases while awaiting cardiac recovery or transplantation, or in some cases as destination therapy. While left ventricular assist device (LVAD) therapy alone is effective in many instances, up to 50% of LVAD recipients demonstrate clinically significant postoperative right ventricular failure and potentially need a biventricular assist device (BiVAD). In these cases, the BiVAD can effectively support both sides of the failing heart. This article presents a technical review of BiVADs, both clinically applied and under development. The BiVADs which have been used clinically are predominantly first generation, pulsatile, and paracorporeal systems that are bulky and prone to device failure, thrombus formation, and infection. While they have saved many lives, they generally necessitate a large external pneumatic driver which inhibits normal movement and quality of life for many patients. In an attempt to alleviate these issues, several smaller, implantable second and third generation devices that use either immersed mechanical blood bearings or hydrodynamic/magnetic levitation systems to support a rotating impeller are under development or in the early stages of clinical use. Although these rotary devices may offer a longer term, completely implantable option for patients with biventricular failure, their control strategies need to be refined to compete with the inherent volume balancing ability of the first generation devices. The BiVAD systems potentially offer an improved quality of life to patients with total heart failure, and thus a viable alternative to heart transplantation is anticipated with continued development.

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Mechanical Circulatory Support in Infants and Adults With the MEDOS/HIA Assist Device

Cited by 14 publications

References 11 publications

The Pediatric Mechanical Circulatory Support Program in Innsbruck, Austria, and the Impact of Such Programs on Lack of Donor Hearts in Europe

The Pediatric Mechanical Circulatory Support Program in Innsbruck, Austria, and the Impact of Such Programs on Lack of Donor Hearts in Europe

Levitronix as a Short-term Salvage Treatment for Primary Graft Failure After Heart Transplantation

Biventricular Assist Devices: A Technical Review

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