Successful Explantation of Berlin Heart Excor in Two Young Children

Abstract

Berlin Heart EXCOR ventricular assist device (VAD) implantation in children is widely used as bridge-to-heart transplantation. Berlin left ventricular assist device (LVAD) support as a bridge to recovery is rare. There is a scarcity of literature describing systematic evaluation in pediatric VAD explantation. Patient 1. A 3 month old boy presented with acute heart failure secondary to myocarditis. An echocardiogram demonstrated severely depressed left ventricular function. He required ECMO cannulation and was decannulated 11 days later. He continued to be hemodynamically unstable and required Berlin LVAD implantation with the intent to bridge to transplantation. Patient 2. A 3 month old boy presented initially with a heart rate of 250 beats/min and an electrocardiogram showed multifocal atrial tachycardia. An echocardiogram showed severely decreased left ventricular function. He was placed on ECMO due to unstable hemodynamics. He did not tolerate ECMO decannulation due to persistent chaotic atrial rhythm and underwent Berlin LVAD implantation with the intent to bridge to transplantation. After both patients showed evidence of myocardial recovery, they underwent a weaning protocol that includes: screening, trial-off with echocardiography, and trial-off in the catheterization suite. Our patients met the criteria and underwent successful explantation. Explantation of VAD can be successfully performed even in young children with appropriate candidate selection and a multidisciplinary and systematic approach.

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

“…Lastly, the lack of universally accepted, evidence-based protocols for both implanting and possible weaning of VAD support are likely to shape outcome as well as recovery rates [ 36 ]. In the last few years, a few protocols have been suggested in the literature [ 7 , 8 , 32 , 34 , 37 , 38 ]. Although most of them use echocardiographic parameters and vital signs such as heart rate and blood pressure to evaluate myocardial recovery, substantial differences exist among them.…”

“…Although most of them use echocardiographic parameters and vital signs such as heart rate and blood pressure to evaluate myocardial recovery, substantial differences exist among them. For example, invasive haemodynamic measurements are often done, but various thresholds are used [ 7 , 34 , 37 , 38 ], and some centres are not convinced of the added value of Swan Ganz measurements to select patients for VAD explantation [ 8 ]. Additionally, a minimum duration of support is sometimes included in the criteria before myocardial recovery is evaluated [ 8 , 34 ], and the duration of off-pump trials varies widely [ 7 , 32 , 34 , 38 ].…”

“…For example, invasive haemodynamic measurements are often done, but various thresholds are used [ 7 , 34 , 37 , 38 ], and some centres are not convinced of the added value of Swan Ganz measurements to select patients for VAD explantation [ 8 ]. Additionally, a minimum duration of support is sometimes included in the criteria before myocardial recovery is evaluated [ 8 , 34 ], and the duration of off-pump trials varies widely [ 7 , 32 , 34 , 38 ]. Furthermore, not all patients who are weaned meet all weaning criteria [ 37 ].…”