HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Roland Hetzer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stiller, B. Articles by Hetzer, R. Search for Related Content PubMed PubMed Citation Articles by Stiller, B. Articles by Hetzer, R. Related Collections Congenital - acyanotic Mechanical Circulatory Assistance

Eur J Cardiothorac Surg 2005;28:234-239
© 2005 Elsevier Science NL

Original articles

Pneumatic pulsatile ventricular assist devices in children under 1 year of age

^a Department of Pediatric Cardiology, Deutsches Herzzentrum Berlin, 13353 Berlin, Germany
^b Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
^c Department of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany

Received 29 October 2004; received in revised form 13 April 2005; accepted 25 April 2005.

^* Corresponding author. Address: Abteilung für Angeborene Herzfehler, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Tel.: +49 30 4593 2800; fax: +49 30 4593 2900. (Email: stiller{at}dhzb.de).

Abstract

Objective: Although considerable progress has been made on ventricular assist devices (VAD) for adults, pneumatic pulsatile circulatory support in young infants is still limited. There is a need for long-term ventricular assist devices to bridge the failing myocardium of young children until recovery or transplantation. Miniaturized devices and innovative modalities need to be optimized. We report on our experience. Methods: From 1/1992 to 6/2004, 18 infants (6 male/12 female) under 1 year of age were treated with the Berlin Heart Excor VAD. The infants were divided into two groups, depending on the year of treatment. Group A consists of eight infants resuscitated and supported with a pulsatile pneumatic ventricular assist device between 1992 and 1998 and group B consists of 10 infants treated between 1999 and 6/2004. With the pediatric-sized Berlin Heart we used miniaturized extracorporeal pneumatically driven blood pumps, the lowest stroke volume being 10ml. Results: In 18 children, age 3–345 (median 147) days, artificial replacement of heart function was applied for long-term support (1–64, median 10 days) as a life-saving measure in our hospital. Nine had LVAD and nine BVAD support. All were in cardiogenic shock with multiorgan failure; three had fulminant myocarditis, four cardiomyopathy, and one chronic stage of congenital heart disease. Five children were weaned from the system, three reached heart transplantation, and 10 died on the VAD. There were no differences between groups A and B regarding age, body weight or diagnosis, but the duration of mechanical support differed: Group A, median 2, range 1–16 days; group B, median 12, range 1–100 days. Since 1999 (group B), the survival rate of our small infants has increased to 70% whereas none of the infants in group A survived to be discharged. Conclusions: The outcome of VAD support in small infants is no longer inferior to that of adult support, now optimized cannulas, modified anticoagulation and optimized surgical and intensive care management have been established.

Key Words: Ventricular assist device • Berlin Heart • Infants • Mechanical circulatory support

This article has been cited by other articles:

				P. Monagle, E. Chalmers, A. Chan, G. deVeber, F. Kirkham, P. Massicotte, and A. D. Michelson Antithrombotic Therapy in Neonates and Children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 887S - 968S. [Abstract] [Full Text] [PDF]

				A. Masuoka, T. Katogi, H. Asano, M. Iwazaki, T. Matsuoka, M. Nishimura, and S. Kyo Successful Use of the Toyobo Left Ventricular Assist Device in a 16-kg Girl Awaiting Cardiac Transplantation Ann. Thorac. Surg., March 1, 2007; 83(3): 1181 - 1183. [Abstract] [Full Text] [PDF]

				B. L. Steenwyk, J. K. Kirklin, W. Q. Gurley, and V. G. Nielsen The Hemostatic History of a 15-Month-Old Child Implanted with a Berlin Heart Left Ventricular Assist Device Anesth. Analg., March 1, 2007; 104(3): 538 - 540. [Abstract] [Full Text] [PDF]

				M. S. Sharma, S. A. Webber, V. O. Morell, S. K. Gandhi, P. D. Wearden, J. R. Buchanan, and R. L. Kormos Ventricular assist device support in children and adolescents as a bridge to heart transplantation. Ann. Thorac. Surg., September 1, 2006; 82(3): 926 - 932. [Abstract] [Full Text] [PDF]

				L. Mildh, P. Tynkkynen, I. Mattila, and P. Rautiainen Initial experience of enoxaparine as anticoagulant during mechanical circulatory support in children Interactive CardioVascular and Thoracic Surgery, August 1, 2006; 5(4): 499 - 501. [Abstract] [Full Text] [PDF]

				D. Rosenthal and D. Bernstein Pediatric Mechanical Circulatory Support: Challenges and Opportunities Circulation, May 16, 2006; 113(19): 2266 - 2268. [Full Text] [PDF]