Pneumatic Paracorporeal Ventricular Assist Device in Infants and Children: Initial Stanford Experience

S. Chris Malaisrie, Marc P. Pelletier, James J. Yun, Kapil Sharma, Tomasz A. Timek, David N. Rosenthal, Gail E. Wright, Robert C. Robbins, Bruce A. Reitz*

*Corresponding author for this work

Research output: Contribution to journalArticle

79 Scopus citations

Abstract

Background: Mechanical circulatory support with the Berlin Heart EXCOR pediatric ventricular assist device (VAD) has been used successfully in Europe for children with cardiac failure. Eighty-seven devices have been placed in North America through February 2007. We describe our single-center experience in 8 children. Methods: Eight children (ages 4 to 55 months), with median weight of 9.6 kg and body surface area of 0.48 m2, received the Berlin Heart VAD as a bridge to transplantation. All patients were in cardiogenic shock requiring multiple inotropes. Primary diagnoses were idiopathic dilated cardiomyopathy (n = 4), congenital heart disease (n = 3) and restrictive cardiomyopathy (n = 1). After device insertion, all patients were treated with an anti-coagulant (heparin or coumadin) and one or more platelet inhibitors (aspirin with clopidogrel or dipyridamole). Results: Five patients received support with a left ventricular assist device (LVAD) and 3 with a biventricular device (BiVAD). Duration of support ranged from 2 to 234 days (median 57 days). Five patients (63%) were successfully bridged to transplantation; of these, 4 were discharged home and 1 died from early graft failure. Five patients developed post-operative neurologic events. Of these 5 events, 4 could be explained by embolism or hemorrhage. Device exchange was performed in 4 patients in the intensive care unit. Conclusions: In selected children, the Berlin Heart VAD can be used as a bridge to transplantation. In contrast to the published European experience, neurologic events occur frequently. Anti-coagulation and platelet inhibition strategies continue to evolve. Device exchange is technically feasible at the bedside and should be considered at the earliest visualization of thrombus formation.

Original languageEnglish (US)
Pages (from-to)173-177
Number of pages5
JournalJournal of Heart and Lung Transplantation
Volume27
Issue number2
DOIs
StatePublished - Feb 1 2008

ASJC Scopus subject areas

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

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    Malaisrie, S. C., Pelletier, M. P., Yun, J. J., Sharma, K., Timek, T. A., Rosenthal, D. N., Wright, G. E., Robbins, R. C., & Reitz, B. A. (2008). Pneumatic Paracorporeal Ventricular Assist Device in Infants and Children: Initial Stanford Experience. Journal of Heart and Lung Transplantation, 27(2), 173-177. https://doi.org/10.1016/j.healun.2007.11.567