Outcome of mechanical cardiac support in children using more than one modality as a bridge to heart transplantation

Fabrizio De Rita, Asif Hasan, Simon Haynes, Edward Peng, Fabrizio Gandolfo, Lee Ferguson, Richard Kirk, Jon Smith, Massimo Griselli

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

OBJECTIVES: Mechanical cardiac support (MCS) can successfully be applied as a bridging strategy for heart transplantation (OHTx) in children with life-threatening heart failure. Emergent use of MCS is often required before establishing the likelihood of OHTx. This can require bridge-to-bridge strategies to increase survival on the waiting list. We compared the outcome of children with heart failure who underwent single MCS with those who required multiple MCS as a bridge to OHTx. METHODS: A retrospective study of patients aged less than 16 years was conducted. From March 1998 to October 2005, we used either a veno-arterial extracorporeal membrane oxygenator (VA-ECMO), or the Medos® para-corporeal ventricular assist device (VAD). From November 2005 onwards, the Berlin Heart EXCOR® (BHE) device was implanted in the majority of cases. Several combinations of bridgeto- bridge strategies have been used: VA-ECMO and then conversion to BHE; BHE and then conversion to VA-ECMO; left VAD and then upgraded to biventricular support (BIVAD); conversion from pulsatile to continuous-flow pumps. RESULTS: A total of 92 patients received MCS with the intent to bridge to OHTx, including 21 (23%) supported with more than one modality. The mean age and weight at support was similar in both groups, but multimodality MCS was used more often in infancy (P = 0.008) and in children less than 10 kg in weight (P = 0.02). The mean duration of support was longer in the multiple MCS group: 40 ± 48 vs 84 ± 43 days (P = 0.0003). Usage of multimodality MCS in dilated cardiomyopathy (19%) and in other diagnoses (29%) was comparable. Incidence of major morbidity (haematological sequelae, cerebrovascular events and sepsis) was similar in both groups. Survival to OHTx/ explantation of the device (recovery) and survival to discharge did not differ between single MCS and multiple MCS groups (78 vs 81% and 72 vs 76%, respectively). CONCLUSION: Bridge to OHTx with multiple MCS does not seem to influence the outcome in our population. Infancy and body weight less than 10 kg do not tend to produce higher mortality in the multiple MCS group. However, children receiving more than one modality are supported for longer durations.

Original languageEnglish (US)
Pages (from-to)917-922
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume48
Issue number6
DOIs
StatePublished - Jan 1 2015

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Membrane Oxygenators
Heart Transplantation
Self-Help Groups
Berlin
Heart-Assist Devices
Survival
Heart Failure
Weights and Measures
Equipment and Supplies
Waiting Lists
Dilated Cardiomyopathy
Sepsis
Retrospective Studies
Body Weight
Morbidity
Mortality
Incidence
Population

Keywords

  • ECMO
  • Heart failure
  • Heart transplantation
  • Mechanical circulatory support
  • Paediatrics

ASJC Scopus subject areas

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

Cite this

Outcome of mechanical cardiac support in children using more than one modality as a bridge to heart transplantation. / De Rita, Fabrizio; Hasan, Asif; Haynes, Simon; Peng, Edward; Gandolfo, Fabrizio; Ferguson, Lee; Kirk, Richard; Smith, Jon; Griselli, Massimo.

In: European Journal of Cardio-thoracic Surgery, Vol. 48, No. 6, 01.01.2015, p. 917-922.

Research output: Contribution to journalArticle

De Rita, F, Hasan, A, Haynes, S, Peng, E, Gandolfo, F, Ferguson, L, Kirk, R, Smith, J & Griselli, M 2015, 'Outcome of mechanical cardiac support in children using more than one modality as a bridge to heart transplantation', European Journal of Cardio-thoracic Surgery, vol. 48, no. 6, pp. 917-922. https://doi.org/10.1093/ejcts/ezu544
De Rita, Fabrizio ; Hasan, Asif ; Haynes, Simon ; Peng, Edward ; Gandolfo, Fabrizio ; Ferguson, Lee ; Kirk, Richard ; Smith, Jon ; Griselli, Massimo. / Outcome of mechanical cardiac support in children using more than one modality as a bridge to heart transplantation. In: European Journal of Cardio-thoracic Surgery. 2015 ; Vol. 48, No. 6. pp. 917-922.
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abstract = "OBJECTIVES: Mechanical cardiac support (MCS) can successfully be applied as a bridging strategy for heart transplantation (OHTx) in children with life-threatening heart failure. Emergent use of MCS is often required before establishing the likelihood of OHTx. This can require bridge-to-bridge strategies to increase survival on the waiting list. We compared the outcome of children with heart failure who underwent single MCS with those who required multiple MCS as a bridge to OHTx. METHODS: A retrospective study of patients aged less than 16 years was conducted. From March 1998 to October 2005, we used either a veno-arterial extracorporeal membrane oxygenator (VA-ECMO), or the Medos{\circledR} para-corporeal ventricular assist device (VAD). From November 2005 onwards, the Berlin Heart EXCOR{\circledR} (BHE) device was implanted in the majority of cases. Several combinations of bridgeto- bridge strategies have been used: VA-ECMO and then conversion to BHE; BHE and then conversion to VA-ECMO; left VAD and then upgraded to biventricular support (BIVAD); conversion from pulsatile to continuous-flow pumps. RESULTS: A total of 92 patients received MCS with the intent to bridge to OHTx, including 21 (23{\%}) supported with more than one modality. The mean age and weight at support was similar in both groups, but multimodality MCS was used more often in infancy (P = 0.008) and in children less than 10 kg in weight (P = 0.02). The mean duration of support was longer in the multiple MCS group: 40 ± 48 vs 84 ± 43 days (P = 0.0003). Usage of multimodality MCS in dilated cardiomyopathy (19{\%}) and in other diagnoses (29{\%}) was comparable. Incidence of major morbidity (haematological sequelae, cerebrovascular events and sepsis) was similar in both groups. Survival to OHTx/ explantation of the device (recovery) and survival to discharge did not differ between single MCS and multiple MCS groups (78 vs 81{\%} and 72 vs 76{\%}, respectively). CONCLUSION: Bridge to OHTx with multiple MCS does not seem to influence the outcome in our population. Infancy and body weight less than 10 kg do not tend to produce higher mortality in the multiple MCS group. However, children receiving more than one modality are supported for longer durations.",
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AU - Hasan, Asif

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AU - Gandolfo, Fabrizio

AU - Ferguson, Lee

AU - Kirk, Richard

AU - Smith, Jon

AU - Griselli, Massimo

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N2 - OBJECTIVES: Mechanical cardiac support (MCS) can successfully be applied as a bridging strategy for heart transplantation (OHTx) in children with life-threatening heart failure. Emergent use of MCS is often required before establishing the likelihood of OHTx. This can require bridge-to-bridge strategies to increase survival on the waiting list. We compared the outcome of children with heart failure who underwent single MCS with those who required multiple MCS as a bridge to OHTx. METHODS: A retrospective study of patients aged less than 16 years was conducted. From March 1998 to October 2005, we used either a veno-arterial extracorporeal membrane oxygenator (VA-ECMO), or the Medos® para-corporeal ventricular assist device (VAD). From November 2005 onwards, the Berlin Heart EXCOR® (BHE) device was implanted in the majority of cases. Several combinations of bridgeto- bridge strategies have been used: VA-ECMO and then conversion to BHE; BHE and then conversion to VA-ECMO; left VAD and then upgraded to biventricular support (BIVAD); conversion from pulsatile to continuous-flow pumps. RESULTS: A total of 92 patients received MCS with the intent to bridge to OHTx, including 21 (23%) supported with more than one modality. The mean age and weight at support was similar in both groups, but multimodality MCS was used more often in infancy (P = 0.008) and in children less than 10 kg in weight (P = 0.02). The mean duration of support was longer in the multiple MCS group: 40 ± 48 vs 84 ± 43 days (P = 0.0003). Usage of multimodality MCS in dilated cardiomyopathy (19%) and in other diagnoses (29%) was comparable. Incidence of major morbidity (haematological sequelae, cerebrovascular events and sepsis) was similar in both groups. Survival to OHTx/ explantation of the device (recovery) and survival to discharge did not differ between single MCS and multiple MCS groups (78 vs 81% and 72 vs 76%, respectively). CONCLUSION: Bridge to OHTx with multiple MCS does not seem to influence the outcome in our population. Infancy and body weight less than 10 kg do not tend to produce higher mortality in the multiple MCS group. However, children receiving more than one modality are supported for longer durations.

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KW - ECMO

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