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

Abstract

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.

Ventricular Assist Device Application With the Intermediate Use of a Membrane Oxygenator as a Bridge to Pediatric Heart Transplantation

“…[3][4][5][6][8][9][10][11][12][13] has been the cornerstone of treatment of severe life-threatening congestive heart failure, but VAD offers a longer-lasting solution when a long-term bridge to heart transplantation is considered. 4,5 ECMO is the procedure of choice in the face of respiratory failure because the system includes an oxygenator that enables ECMO to work both as a pump and as a lung in the setting of circulatory and respiratory failure.…”

Limitations Of High Urgency Listing – Ventricular Assist Device Support in a Neonate for 452 Days

“…452 days of VAD support is rare in newborns and, until a few years ago, was rare even in adults. Other reports describe maximum support durations for pediatric patients between 64 and 231 days in the US and in Europe [7][8][9][10]. The average VAD support duration until transplantation in our center was so far 89 ± 95 days with a maximum waiting period of 280 days [11].…”

How Mechanical Circulatory Support Helps Not to Need It-New Strategies in Pediatric Heart Failure

“…In experienced hands, more than 90% of patients survive to destination therapy (weaning or heart transplantation) with survival to discharge better than 75% even in the first year of life (1). We established a pediatric circulatory assist device program in 2000 and were able to reproduce these good results at our center (2,3). During the past 3 years, only one patient was supported with extracorporeal membrane oxygenation (ECMO) for 16 days at our center, despite the fact that seven patients with acute heart failure were treated in that period without mortality.…”