Mechanical Cardiac Support with Berlin Heart EXCOR Pulsatile Ventricular Assist Device in Infants and Children: 23-Year Single Center Experience

Object: We present outcome of infants and children undergoing mechanical cardiac support with Berlin Heart EXCOR ventricular assist device (BH-VAD) over a period of 23 years.

Methods: Between 1990 and 4/2013, BH-VAD was used in 115 children (2 days-17 years, median: 2 years) due to profound HF. Of these, 15 were infants (median 125 days). CMP was present in 50.5%, fulminant myocarditis in 13.9%, end-stage CHD in 16.8%, and postcardiac surgery in 18.8%. According to the period of BH-VAD implantation, three periods were screened: period I (1990 – 1999, n= 39), period II (2000 – 2006, n= 34), and period III (2007 – 4/2013, n= 42). Endpoints were HTx, myocardial recovery and VAD weaning, death while on VAD or discharge home.

Results: Overall mean support time was 65.7 days (range: 1 – 812 days, median: 26 days) with three children still on VAD. Mean time on a VAD was significantly shorter in period I (28 days) than in period II (52.3 days) and III (79 days) concomitant with a decrease of mean age at VAD implantation from 8.1 to 7 and 5.7 years. Overall, 46 out of 115 patients were transplanted (40%). HTx rate decreased from period II (50%) to III (33.3%). Recovery and VAD weaning was achieved in 20 patients (17.4%) after 6 to 125 days of support. Overall survival until HTx or after weaning to discharge home was 62%. Forty-nine patients died on VAD from complications.

Conclusions: BH-VAD provides efficient and highly reliable mechanical circulatory support in infants and children with advanced heart failure with equally good results for weeks and months. Clinical aim is either qualify for successful HTx or completely recover. Due to organ shortage, mean supporting time significantly increased over the study period.