Management of Single-Ventricle Patients With Berlin Heart EXCOR Ventricular Assist Device

Single-Center Experience

Tracey Mackling*, Tejas Shah, Vivian Dimas, Kristine Guleserian, Mahesh Sharma, Joseph Forbess, Monica Ardura, Jami Gross-Toalson, Ying Lee, Janna Journeycake, Aliessa Barnes

*Corresponding author for this work

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

There are minimal data regarding chronic management of single-ventricle ventricular assist device (VAD) patients. This study aims to describe our center's multidisciplinary team management of single-ventricle patients supported long term with the Berlin Heart EXCOR Pediatric VAD. Patient #1 was a 4-year-old with double-outlet right ventricle with aortic atresia, L-looped ventricles, and heart block who developed heart failure 1 year after Fontan. She initially required extracorporeal membrane oxygenation support and was transitioned to Berlin Heart systemic VAD. She was supported for 363 days (cardiac intensive care unit [CICU] 335 days, floor 28 days). The postoperative course was complicated by intermittent infection including methicillin-resistant Staphylococcus aureus, intermittent hepatic and renal insufficiencies, and transient antithrombin, protein C, and protein S deficiencies resulting in multiple thrombi. She had a total of five pump changes over 10 months. Long-term medical management included anticoagulation with enoxaparin, platelet inhibition with aspirin and dipyridamole, and antibiotic prophylaxis using trimethoprim/sulfamethoxazole. She developed sepsis of unknown etiology and subsequently died from multiorgan failure. Patient #2 was a 4-year-old with hypoplastic left heart syndrome who developed heart failure 2 years after bidirectional Glenn shunt. At systemic VAD implantation, he was intubated with renal insufficiency. Post-VAD implantation, his renal insufficiency resolved, and he was successfully extubated to daytime nasal cannula and biphasic positive airway pressure at night. He was supported for 270 days (CICU 143 days, floor 127 days). The pump was upsized to a 50-mL pump in May 2011 for increased central venous pressures (29mmHg). Long-term medical management included anticoagulation with warfarin and single-agent platelet inhibition using dipyridamole due to aspirin resistance. He developed increased work of breathing requiring intubation, significant anasarca, and bleeding from the endotracheal tube. The family elected to withdraw support. Although both patients died prior to heart transplantation, a consistent specialized multidisciplinary team approach to the medical care of our VAD patients, consisting of cardiothoracic surgeons, heart transplant team, hematologists, pharmacists, infectious disease physicians, psychiatrists, specialty trained bedside nursing, and nurse practitioners, allowed us to manage these patients long term while awaiting heart transplantation.

Original languageEnglish (US)
Pages (from-to)555-559
Number of pages5
JournalArtificial Organs
Volume36
Issue number6
DOIs
StatePublished - Jun 1 2012

Fingerprint

Heart-Assist Devices
Berlin
Renal Insufficiency
Dipyridamole
Heart Transplantation
Intensive care units
Aspirin
Intensive Care Units
Pumps
Platelets
Blood Platelets
Heart Failure
Antithrombin Proteins
Double Outlet Right Ventricle
Protein S Deficiency
Work of Breathing
Hypoplastic Left Heart Syndrome
Hepatic Insufficiency
Fontan Procedure
Enoxaparin

Keywords

  • Berlin Heart EXCOR
  • Single ventricle
  • Ventricular assist device

ASJC Scopus subject areas

  • Biomaterials
  • Biomedical Engineering
  • Bioengineering
  • Medicine (miscellaneous)

Cite this

Mackling, Tracey ; Shah, Tejas ; Dimas, Vivian ; Guleserian, Kristine ; Sharma, Mahesh ; Forbess, Joseph ; Ardura, Monica ; Gross-Toalson, Jami ; Lee, Ying ; Journeycake, Janna ; Barnes, Aliessa. / Management of Single-Ventricle Patients With Berlin Heart EXCOR Ventricular Assist Device : Single-Center Experience. In: Artificial Organs. 2012 ; Vol. 36, No. 6. pp. 555-559.
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Mackling, T, Shah, T, Dimas, V, Guleserian, K, Sharma, M, Forbess, J, Ardura, M, Gross-Toalson, J, Lee, Y, Journeycake, J & Barnes, A 2012, 'Management of Single-Ventricle Patients With Berlin Heart EXCOR Ventricular Assist Device: Single-Center Experience', Artificial Organs, vol. 36, no. 6, pp. 555-559. https://doi.org/10.1111/j.1525-1594.2011.01403.x

Management of Single-Ventricle Patients With Berlin Heart EXCOR Ventricular Assist Device : Single-Center Experience. / Mackling, Tracey; Shah, Tejas; Dimas, Vivian; Guleserian, Kristine; Sharma, Mahesh; Forbess, Joseph; Ardura, Monica; Gross-Toalson, Jami; Lee, Ying; Journeycake, Janna; Barnes, Aliessa.

In: Artificial Organs, Vol. 36, No. 6, 01.06.2012, p. 555-559.

Research output: Contribution to journalArticle

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AU - Dimas, Vivian

AU - Guleserian, Kristine

AU - Sharma, Mahesh

AU - Forbess, Joseph

AU - Ardura, Monica

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AU - Lee, Ying

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AU - Barnes, Aliessa

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N2 - There are minimal data regarding chronic management of single-ventricle ventricular assist device (VAD) patients. This study aims to describe our center's multidisciplinary team management of single-ventricle patients supported long term with the Berlin Heart EXCOR Pediatric VAD. Patient #1 was a 4-year-old with double-outlet right ventricle with aortic atresia, L-looped ventricles, and heart block who developed heart failure 1 year after Fontan. She initially required extracorporeal membrane oxygenation support and was transitioned to Berlin Heart systemic VAD. She was supported for 363 days (cardiac intensive care unit [CICU] 335 days, floor 28 days). The postoperative course was complicated by intermittent infection including methicillin-resistant Staphylococcus aureus, intermittent hepatic and renal insufficiencies, and transient antithrombin, protein C, and protein S deficiencies resulting in multiple thrombi. She had a total of five pump changes over 10 months. Long-term medical management included anticoagulation with enoxaparin, platelet inhibition with aspirin and dipyridamole, and antibiotic prophylaxis using trimethoprim/sulfamethoxazole. She developed sepsis of unknown etiology and subsequently died from multiorgan failure. Patient #2 was a 4-year-old with hypoplastic left heart syndrome who developed heart failure 2 years after bidirectional Glenn shunt. At systemic VAD implantation, he was intubated with renal insufficiency. Post-VAD implantation, his renal insufficiency resolved, and he was successfully extubated to daytime nasal cannula and biphasic positive airway pressure at night. He was supported for 270 days (CICU 143 days, floor 127 days). The pump was upsized to a 50-mL pump in May 2011 for increased central venous pressures (29mmHg). Long-term medical management included anticoagulation with warfarin and single-agent platelet inhibition using dipyridamole due to aspirin resistance. He developed increased work of breathing requiring intubation, significant anasarca, and bleeding from the endotracheal tube. The family elected to withdraw support. Although both patients died prior to heart transplantation, a consistent specialized multidisciplinary team approach to the medical care of our VAD patients, consisting of cardiothoracic surgeons, heart transplant team, hematologists, pharmacists, infectious disease physicians, psychiatrists, specialty trained bedside nursing, and nurse practitioners, allowed us to manage these patients long term while awaiting heart transplantation.

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