The use of the Berlin heart EXCOR in patients with functional single ventricle

Samuel Weinstein, Ricardo Bello, Christian Pizarro, Francis Fynn-Thompson, James Kirklin, Kristine Guleserian, Ronald Woods, Christine Tjossem, Robert Kroslowitz, Patricia Friedmann, Robert Jaquiss

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Introduction The frequency and successful use of pediatric ventricular assist devices (VADs) as a bridge to cardiac transplantation have been steadily increasing since 2003, but the experience in patients with complex congenital heart disease has not been well described. Using a large prospectively collected dataset of children supported with the Berlin Heart EXCOR VAD, we have reviewed the experience in children with single ventricular anatomy or physiology (SV), and compared the results with those supported with biventricular circulation (BV) over the same time period. Methods The EXCOR Investigational Device Exemption study database was retrospectively reviewed. VAD implants under the primary cohort and compassionate use cohort between May 2007 and December 2011 were included in this review. Results Twenty-six of 281 patients supported with a VAD were SV. The most common diagnosis was hypoplastic left heart syndrome (15 of 26). Nine patients were supported after neonatal palliative surgery (Blalock-Taussig shunt or Sano), 12 after a superior cavopulmonary connection (SCPC), and 5 after total cavopulmonary connection (TCPC). Two patients received biventricular assist devices, 1 after stage I surgery and 1 after stage II. SV patients were supported for a median time of 10.5 days (range, 1-363 days) versus 39 days (range, 0-435 days) for BV (P =.01). The ability to be bridged to transplant or recovery in SV patients is lower than for BV patients (11 of 26 [42.3%] vs 185 of 255 [72.5%]; P =.001). Three of 5 patients with TCPC were successfully bridged to transplant and were supported with 1 VAD. Seven of 12 patients with SCPC were bridged to transplant, and only 1 of 9 patients supported after a stage I procedure survived. Conclusions The EXCOR Pediatric VAD can provide a bridge to transplant for children with SV anatomy or physiology, albeit less successfully than in children with BV. In this small series, results are better in patients with SCPC and TCPC. VAD support for patients with shunted sources of pulmonary blood flow should be applied with caution.

Original languageEnglish (US)
Pages (from-to)697-705
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume147
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Berlin
Heart-Assist Devices
Transplants
Anatomy
Compassionate Use Trials
Blalock-Taussig Procedure
Pediatrics
Hypoplastic Left Heart Syndrome
Equipment and Supplies
Heart Transplantation
Palliative Care
Heart Diseases
Databases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

The use of the Berlin heart EXCOR in patients with functional single ventricle. / Weinstein, Samuel; Bello, Ricardo; Pizarro, Christian; Fynn-Thompson, Francis; Kirklin, James; Guleserian, Kristine; Woods, Ronald; Tjossem, Christine; Kroslowitz, Robert; Friedmann, Patricia; Jaquiss, Robert.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 147, No. 2, 02.2014, p. 697-705.

Research output: Contribution to journalArticle

Weinstein, S, Bello, R, Pizarro, C, Fynn-Thompson, F, Kirklin, J, Guleserian, K, Woods, R, Tjossem, C, Kroslowitz, R, Friedmann, P & Jaquiss, R 2014, 'The use of the Berlin heart EXCOR in patients with functional single ventricle', Journal of Thoracic and Cardiovascular Surgery, vol. 147, no. 2, pp. 697-705. https://doi.org/10.1016/j.jtcvs.2013.10.030
Weinstein, Samuel ; Bello, Ricardo ; Pizarro, Christian ; Fynn-Thompson, Francis ; Kirklin, James ; Guleserian, Kristine ; Woods, Ronald ; Tjossem, Christine ; Kroslowitz, Robert ; Friedmann, Patricia ; Jaquiss, Robert. / The use of the Berlin heart EXCOR in patients with functional single ventricle. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 147, No. 2. pp. 697-705.
@article{1e08b1f78f4447aca2e081507a050f36,
title = "The use of the Berlin heart EXCOR in patients with functional single ventricle",
abstract = "Introduction The frequency and successful use of pediatric ventricular assist devices (VADs) as a bridge to cardiac transplantation have been steadily increasing since 2003, but the experience in patients with complex congenital heart disease has not been well described. Using a large prospectively collected dataset of children supported with the Berlin Heart EXCOR VAD, we have reviewed the experience in children with single ventricular anatomy or physiology (SV), and compared the results with those supported with biventricular circulation (BV) over the same time period. Methods The EXCOR Investigational Device Exemption study database was retrospectively reviewed. VAD implants under the primary cohort and compassionate use cohort between May 2007 and December 2011 were included in this review. Results Twenty-six of 281 patients supported with a VAD were SV. The most common diagnosis was hypoplastic left heart syndrome (15 of 26). Nine patients were supported after neonatal palliative surgery (Blalock-Taussig shunt or Sano), 12 after a superior cavopulmonary connection (SCPC), and 5 after total cavopulmonary connection (TCPC). Two patients received biventricular assist devices, 1 after stage I surgery and 1 after stage II. SV patients were supported for a median time of 10.5 days (range, 1-363 days) versus 39 days (range, 0-435 days) for BV (P =.01). The ability to be bridged to transplant or recovery in SV patients is lower than for BV patients (11 of 26 [42.3{\%}] vs 185 of 255 [72.5{\%}]; P =.001). Three of 5 patients with TCPC were successfully bridged to transplant and were supported with 1 VAD. Seven of 12 patients with SCPC were bridged to transplant, and only 1 of 9 patients supported after a stage I procedure survived. Conclusions The EXCOR Pediatric VAD can provide a bridge to transplant for children with SV anatomy or physiology, albeit less successfully than in children with BV. In this small series, results are better in patients with SCPC and TCPC. VAD support for patients with shunted sources of pulmonary blood flow should be applied with caution.",
author = "Samuel Weinstein and Ricardo Bello and Christian Pizarro and Francis Fynn-Thompson and James Kirklin and Kristine Guleserian and Ronald Woods and Christine Tjossem and Robert Kroslowitz and Patricia Friedmann and Robert Jaquiss",
year = "2014",
month = "2",
doi = "10.1016/j.jtcvs.2013.10.030",
language = "English (US)",
volume = "147",
pages = "697--705",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - The use of the Berlin heart EXCOR in patients with functional single ventricle

AU - Weinstein, Samuel

AU - Bello, Ricardo

AU - Pizarro, Christian

AU - Fynn-Thompson, Francis

AU - Kirklin, James

AU - Guleserian, Kristine

AU - Woods, Ronald

AU - Tjossem, Christine

AU - Kroslowitz, Robert

AU - Friedmann, Patricia

AU - Jaquiss, Robert

PY - 2014/2

Y1 - 2014/2

N2 - Introduction The frequency and successful use of pediatric ventricular assist devices (VADs) as a bridge to cardiac transplantation have been steadily increasing since 2003, but the experience in patients with complex congenital heart disease has not been well described. Using a large prospectively collected dataset of children supported with the Berlin Heart EXCOR VAD, we have reviewed the experience in children with single ventricular anatomy or physiology (SV), and compared the results with those supported with biventricular circulation (BV) over the same time period. Methods The EXCOR Investigational Device Exemption study database was retrospectively reviewed. VAD implants under the primary cohort and compassionate use cohort between May 2007 and December 2011 were included in this review. Results Twenty-six of 281 patients supported with a VAD were SV. The most common diagnosis was hypoplastic left heart syndrome (15 of 26). Nine patients were supported after neonatal palliative surgery (Blalock-Taussig shunt or Sano), 12 after a superior cavopulmonary connection (SCPC), and 5 after total cavopulmonary connection (TCPC). Two patients received biventricular assist devices, 1 after stage I surgery and 1 after stage II. SV patients were supported for a median time of 10.5 days (range, 1-363 days) versus 39 days (range, 0-435 days) for BV (P =.01). The ability to be bridged to transplant or recovery in SV patients is lower than for BV patients (11 of 26 [42.3%] vs 185 of 255 [72.5%]; P =.001). Three of 5 patients with TCPC were successfully bridged to transplant and were supported with 1 VAD. Seven of 12 patients with SCPC were bridged to transplant, and only 1 of 9 patients supported after a stage I procedure survived. Conclusions The EXCOR Pediatric VAD can provide a bridge to transplant for children with SV anatomy or physiology, albeit less successfully than in children with BV. In this small series, results are better in patients with SCPC and TCPC. VAD support for patients with shunted sources of pulmonary blood flow should be applied with caution.

AB - Introduction The frequency and successful use of pediatric ventricular assist devices (VADs) as a bridge to cardiac transplantation have been steadily increasing since 2003, but the experience in patients with complex congenital heart disease has not been well described. Using a large prospectively collected dataset of children supported with the Berlin Heart EXCOR VAD, we have reviewed the experience in children with single ventricular anatomy or physiology (SV), and compared the results with those supported with biventricular circulation (BV) over the same time period. Methods The EXCOR Investigational Device Exemption study database was retrospectively reviewed. VAD implants under the primary cohort and compassionate use cohort between May 2007 and December 2011 were included in this review. Results Twenty-six of 281 patients supported with a VAD were SV. The most common diagnosis was hypoplastic left heart syndrome (15 of 26). Nine patients were supported after neonatal palliative surgery (Blalock-Taussig shunt or Sano), 12 after a superior cavopulmonary connection (SCPC), and 5 after total cavopulmonary connection (TCPC). Two patients received biventricular assist devices, 1 after stage I surgery and 1 after stage II. SV patients were supported for a median time of 10.5 days (range, 1-363 days) versus 39 days (range, 0-435 days) for BV (P =.01). The ability to be bridged to transplant or recovery in SV patients is lower than for BV patients (11 of 26 [42.3%] vs 185 of 255 [72.5%]; P =.001). Three of 5 patients with TCPC were successfully bridged to transplant and were supported with 1 VAD. Seven of 12 patients with SCPC were bridged to transplant, and only 1 of 9 patients supported after a stage I procedure survived. Conclusions The EXCOR Pediatric VAD can provide a bridge to transplant for children with SV anatomy or physiology, albeit less successfully than in children with BV. In this small series, results are better in patients with SCPC and TCPC. VAD support for patients with shunted sources of pulmonary blood flow should be applied with caution.

UR - http://www.scopus.com/inward/record.url?scp=84892366729&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892366729&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2013.10.030

DO - 10.1016/j.jtcvs.2013.10.030

M3 - Article

C2 - 24290716

AN - SCOPUS:84892366729

VL - 147

SP - 697

EP - 705

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 2

ER -