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Outcome of mechanical cardiac support in children using more than one modality as a bridge to heart transplantation

Outcome of mechanical cardiac support in children using more than one modality as a bridge to... OBJECTIVESMechanical cardiac support (MCS) can successfully be applied as a bridging strategy for heart transplantation (OHTx) in children with life-threatening heart failure. Emergent use of MCS is often required before establishing the likelihood of OHTx. This can require bridge-to-bridge strategies to increase survival on the waiting list. We compared the outcome of children with heart failure who underwent single MCS with those who required multiple MCS as a bridge to OHTx.METHODSA retrospective study of patients aged less than 16 years was conducted. From March 1998 to October 2005, we used either a veno-arterial extracorporeal membrane oxygenator (VA-ECMO), or the Medos para-corporeal ventricular assist device (VAD). From November 2005 onwards, the Berlin Heart EXCOR (BHE) device was implanted in the majority of cases. Several combinations of bridge-to-bridge strategies have been used: VA-ECMO and then conversion to BHE; BHE and then conversion to VA-ECMO; left VAD and then upgraded to biventricular support (BIVAD); conversion from pulsatile to continuous-flow pumps.RESULTSA total of 92 patients received MCS with the intent to bridge to OHTx, including 21 (23) supported with more than one modality. The mean age and weight at support was similar in both groups, but multimodality MCS was used more often in infancy (P 0.008) and in children less than 10 kg in weight (P 0.02). The mean duration of support was longer in the multiple MCS group: 40 48 vs 84 43 days (P 0.0003). Usage of multimodality MCS in dilated cardiomyopathy (19) and in other diagnoses (29) was comparable. Incidence of major morbidity (haematological sequelae, cerebrovascular events and sepsis) was similar in both groups. Survival to OHTx/explantation of the device (recovery) and survival to discharge did not differ between single MCS and multiple MCS groups (78 vs 81 and 72 vs 76, respectively).CONCLUSIONBridge to OHTx with multiple MCS does not seem to influence the outcome in our population. Infancy and body weight less than 10 kg do not tend to produce higher mortality in the multiple MCS group. However, children receiving more than one modality are supported for longer durations. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Outcome of mechanical cardiac support in children using more than one modality as a bridge to heart transplantation

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References (16)

Publisher
Oxford University Press
Copyright
The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Subject
TRANSPLANTATION AND MECHANICAL CIRCULATORY SUPPORT
ISSN
1010-7940
eISSN
1873-734X
DOI
10.1093/ejcts/ezu544
pmid
25605831
Publisher site
See Article on Publisher Site

Abstract

OBJECTIVESMechanical cardiac support (MCS) can successfully be applied as a bridging strategy for heart transplantation (OHTx) in children with life-threatening heart failure. Emergent use of MCS is often required before establishing the likelihood of OHTx. This can require bridge-to-bridge strategies to increase survival on the waiting list. We compared the outcome of children with heart failure who underwent single MCS with those who required multiple MCS as a bridge to OHTx.METHODSA retrospective study of patients aged less than 16 years was conducted. From March 1998 to October 2005, we used either a veno-arterial extracorporeal membrane oxygenator (VA-ECMO), or the Medos para-corporeal ventricular assist device (VAD). From November 2005 onwards, the Berlin Heart EXCOR (BHE) device was implanted in the majority of cases. Several combinations of bridge-to-bridge strategies have been used: VA-ECMO and then conversion to BHE; BHE and then conversion to VA-ECMO; left VAD and then upgraded to biventricular support (BIVAD); conversion from pulsatile to continuous-flow pumps.RESULTSA total of 92 patients received MCS with the intent to bridge to OHTx, including 21 (23) supported with more than one modality. The mean age and weight at support was similar in both groups, but multimodality MCS was used more often in infancy (P 0.008) and in children less than 10 kg in weight (P 0.02). The mean duration of support was longer in the multiple MCS group: 40 48 vs 84 43 days (P 0.0003). Usage of multimodality MCS in dilated cardiomyopathy (19) and in other diagnoses (29) was comparable. Incidence of major morbidity (haematological sequelae, cerebrovascular events and sepsis) was similar in both groups. Survival to OHTx/explantation of the device (recovery) and survival to discharge did not differ between single MCS and multiple MCS groups (78 vs 81 and 72 vs 76, respectively).CONCLUSIONBridge to OHTx with multiple MCS does not seem to influence the outcome in our population. Infancy and body weight less than 10 kg do not tend to produce higher mortality in the multiple MCS group. However, children receiving more than one modality are supported for longer durations.

Journal

European Journal of Cardio-Thoracic Surgery – Oxford University Press

Published: Dec 20, 2015

Keywords: Heart failure Mechanical circulatory support ECMO Heart transplantation Paediatrics

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