Ventricular Assist Device for Myocarditis or Cardiomyopathy in Pediatric Patients: A Single-Center Series with no Mortality and the Longest Reported Duration of Support, So Far

Objectives: Outcome evaluation of pediatric patients receiving Berlin Heart EXCOR ventricular assist device (VAD) for myocarditis or cardiomyopathy.

Methods: Eight patients received VAD support between 10/2007 and 04/2012 for cardiomyopathy or myocarditis in a single center. Median age was 4.2 years (range: 6 months-15 years) and median weight 20 kg (range: 6.6 – 61). Biventricular VAD support was needed in two patients, primarily, and VAD-implantation was sufficient for the left ventricle in the remaining six patients. Sizes of implanted VAD EXCOR ventricles were 10 mL (n= 2), 30 mL (n= 3), 50 mL (n= 1), and 60 mL (n= 2) on the left, and 50 mL (n= 2) on the right side, respectively. Follow-up was complete with a mean duration of 2.3 ± 1.8 years.

Results: Median duration of support was 145 days (range: 41 – 877). Early- and long-term mortalities were 0%. Major adverse events during support were cerebral insults in two patients. In four patients, the EXCOR ventricle had to be changed due to beginning thrombotic adhesions (n= 2), or inadequate size (n= 2). In all patients, VAD was successfully explanted as bridge-to-transplant (n= 4) or bridge-to-recovery (n= 4). The longest VAD runs were in a 16-month and 3.8-year-old child at implantation (700 and 877 days of support), respectively.

Conclusion: VAD support due to left or biventricular failure as a result of cardiomyopathy or myocarditis is associated with excellent early and long-term results for pediatric patients in specialized centers. We present the longest periods with left VAD support as bridge-to-transplant and recovery in children, so far reported.