Mechanical cardiac support in children with congenital heart disease with intention to bridge to heart transplantation
Open Access
- 26 February 2014
- journal article
- research article
- Published by Oxford University Press (OUP) in European Journal of Cardio-Thoracic Surgery
- Vol. 46 (4), 656-662
- https://doi.org/10.1093/ejcts/ezu039
Abstract
A significant number of children affected by congenital heart disease (CHD) develop heart failure early or late after surgery, and heart transplantation (OHTx) remains the last treatment option. Due to shortage of donor organs in paediatric group, mechanical circulatory support (MCS) is now routinely applied as bridging strategy to increase survival on the waiting list for OTHx. We sought to assess the impact of MCS as intention to bridge to OHTx in patients with CHD less than 16 years of age. From 1998 to 2013, 106 patients received 113 episodes of MCS with paracorporeal devices as intention to bridge to OHTx. Twenty-nine had CHD, 15 (52%) with two-ventricle (Group A) and 14 (48%) with single-ventricle physiology (Group B). In Group A, 5 children had venoarterial extracorporeal membrane oxygenation (VA ECMO), 6 left ventricular assist device (LVAD), 2 biventricular assist device (BIVAD), 1 VA ECMO followed by BIVAD and 1 BIVAD followed by VA ECMO. In Group B, VA ECMO was used in 7 children, univentricular assist device (UVAD) changed to VA ECMO in 4, UVAD in 2 and surgical conversion to two-ventricles physiology with BIVAD support changed to VA ECMO in 1. Twenty-one of 29 (72%) children survived to recovery/OHTx. Seven of 29 (59%) survived to discharge. In Group A, 11/15 (73%) survived to recovery/OHTx and 9/15 (60%) survived to discharge. Four of 15 (27%) died awaiting OHTx. One child had graft failure requiring VA ECMO and was bridged successfully to retransplantation. One child dying after OHTx had acute rejection, was supported with VA ECMO and then BIVAD but did not recover. One patient had an unsuccessful second run on BIVAD 1 year after recovery from VA ECMO. In Group B, 10/14 (71%) survived to recovery/OHTx and 8/14 (57%) survived to discharge. Four of 14 (29%) died awaiting OHTx. Of deaths after OHTx, 1 occurred intraoperatively and 1 was consequent to graft failure and had an unsuccessful second run with VA ECMO. Children with CHD can be successfully bridged with MCS to heart transplantation. Single-ventricle circulation compared with biventricular physiology does not increase the risk of death before transplant or before hospital discharge.Keywords
This publication has 15 references indexed in Scilit:
- The impact of mechanical circulatory support on outcomes in paediatric heart transplantation†European Journal of Cardio-Thoracic Surgery, 2013
- Berlin Heart EXCOR Pediatric Ventricular Assist Device for Bridge to Heart Transplantation in US ChildrenCirculation, 2013
- The Registry of the International Society for Heart and Lung Transplantation: Fifteenth Pediatric Heart Transplantation Report—2012The Journal of Heart and Lung Transplantation, 2012
- Prospective Trial of a Pediatric Ventricular Assist DeviceNew England Journal of Medicine, 2012
- Single-center experience with treatment of cardiogenic shock in children by pediatric ventricular assist devicesThe Journal of Thoracic and Cardiovascular Surgery, 2011
- The use of ventricular assist devices in pediatric patients with univentricular heartsThe Journal of Thoracic and Cardiovascular Surgery, 2011
- Bridge to Cardiac Transplant in Children: Berlin Heart versus Extracorporeal Membrane OxygenationThe Annals of Thoracic Surgery, 2009
- Successful Bridge to Transplant With the Berlin Heart After Cavopulmonary ShuntThe Journal of Heart and Lung Transplantation, 2009
- Waiting List Mortality Among Children Listed for Heart Transplantation in the United StatesCirculation, 2009
- The Adult With Congenital Heart DiseaseJournal of the American College of Cardiology, 2005