2016
DOI: 10.1093/ejcts/ezw011
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Paediatric mechanical circulatory support with Berlin Heart EXCOR: development and outcome of a 23-year experience

Abstract: This paper reviews the development and establishment of the Berlin Heart EXCOR® (BHE®) as a paediatric mechanical circulatory support and reports our entire experience with regard to indications, timing of implantation and explantation and outcome. The Berlin group reported the first successful paediatric bridge to transplantation using a pulsatile pneumatic paracorporeal biventricular assist device, the BHE®, in 1990 in an 8-year-old boy with end-stage heart failure and coarctation of the aorta. This experien… Show more

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Cited by 77 publications
(70 citation statements)
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References 39 publications
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“…It is likely that management of anticoagulation is the most important causal factor. Achieving effective anticoagulation in the smallest children is very difficult, because of both intrinsic factors related to maturation of the coagulation cascade and reasons related to the logistics of drug administration and frequent blood sampling (16).…”
Section: Discussionmentioning
confidence: 99%
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“…It is likely that management of anticoagulation is the most important causal factor. Achieving effective anticoagulation in the smallest children is very difficult, because of both intrinsic factors related to maturation of the coagulation cascade and reasons related to the logistics of drug administration and frequent blood sampling (16).…”
Section: Discussionmentioning
confidence: 99%
“…Indications for implanting the VADs were (I) low cardiac output with metabolic acidosis; (II) rapid circulatory deterioration with a cardiac index <2.0 L/min/m 2 and/ or dependence on inotropes, particularly epinephrine; (III) mixed venous saturation of <40%; (IV) oliguria (<1 mL/kg/min); (V) critical peripheral perfusion; (VI) massive cardiac impairment as confirmed by echocardiography, despite maximal pharmacological treatment, with signs of early renal, hepatic and/or respiratory failure and high or progressive increase in B-type natriuretic peptide (BNP) or N-terminal proBNP levels (16). The criteria for VAD implantation have been modified over time and shifted towards earlier implantation before irreversible organ damage is established, or after a few days on ECMO to obviate coagulation disorders and infection.…”
Section: Choice Of Pumps and Indications Timing And Techniques Formentioning
confidence: 99%
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“…Neurologic complications have been its Achilles heel. Its stroke rate of 22%‐29% is higher than that of continuous flow devices in children (approx. 15%), although this may be an unfair comparison due to patient size discrepancy …”
Section: Discussionmentioning
confidence: 87%
“…Its success rate as measured by the rate patients are bridged to transplantation or recovery is between 57% and 77% . However, the device is associated with a significant rate of neurologic complications, with a stroke rate of between 22% and 29% . Stroke is thought to be predominantly ischemic due to deposits occurring in the device and their embolization.…”
Section: Introductionmentioning
confidence: 99%