Original article
Pediatric cardiac
Bridge to Cardiac Transplant in Children: Berlin Heart versus Extracorporeal Membrane Oxygenation

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.
https://doi.org/10.1016/j.athoracsur.2009.03.049Get rights and content

Background

For small children requiring mechanical circulatory support as a bridge to transplantation (BTT), extracorporeal membrane oxygenation (ECMO) has been the only option until the recent introduction of the Berlin Heart EXCOR ventricular assist device (Berlin Heart AG, Berlin, Germany). We reviewed our recent experience with these two technologies with particular focus on early outcomes.

Methods

Data for 55 consecutive children undergoing BTT between 2001 and 2008 were abstracted from an institutional database. The analysis excluded 13 patients because EXCOR was not used for acute postcardiotomy BTT. Patients were divided into ECMO (n = 21) and EXCOR groups (n = 21). Specific end points included survival to transplant, overall survival, and bridge to recovery. Incidences of adverse events and the duration of support were determined.

Results

Groups were similar in weight, age, and etiologies of heart failure. Likewise, the incidences of stroke and multisystem organ failure were similar. Survival to transplant, recovery, or continued support was 57% in ECMO and 86% in EXCOR (p = 0.040). EXCOR patients had overall significantly better survival (p = 0.049). Two ECMO patients and 1 EXOR patient were bridged to recovery. The mean duration of support was 15 ± 12 days in the ECMO group and 42 ± 43 days in the EXCOR group (p < 0.001).

Conclusions

In children requiring BTT, EXCOR provided substantially longer support times than ECMO, without significant increase in the rates of stroke or multisystem organ failure. Survival to transplant and long-term survival was higher with EXCOR.

Section snippets

Material and Methods

Permission to proceed with a retrospective review of anonymous patient data was granted by our Institutional Review Board, and the requirement for patient and parent written consent was waived. Between 2001 and November 2008, 42 consecutive patients who were not postcardiotomy required mechanical circulatory support for bridge to transplantation at Arkansas Children's Hospital. During the same period, 13 patients were supported postcardiotomy and were excluded from this analysis because we have

Results

A demographic comparison between the EXCOR and ECMO groups is reported in Table 1. In ECMO patients were slightly younger and smaller, although the differences were not statistically significant. The proportions of congenital heart defects, cardiomyopathy, and myocarditis were similar in both groups. Detailed data about diagnosis and support on each group are given in Table 2, Table 3.Table 4 summarizes the comparison of postsupport profiles, including complications.

Comment

This retrospective comparison of the outcomes for children receiving mechanical support with ECMO or the Berlin Heart EXCOR VAD as a bridge to cardiac transplantation suggests that the EXCOR allows for longer support times and better overall survival. Both support modalities were associated with a significant rate of neurologic complication, but these were less often fatal in the patients supported with VAD.

Since coming into widespread usage as the pediatric bridge modality in the 1990s, ECMO

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