Bad Oeynhausen Experience with Berlin Heart EXCOR in Children with Single- and Two-Ventricle Physiology

Objectives: This retrospective study reviews our results regarding the long-term support with Berlin Heart EXCOR system in pediatric patients with single- and two-ventricle physiology between January 2008 and September 2016.

Methods: We implanted the Berlin Heart EXCOR in 36 patients (median age: 3.37 years; interquartile range [IQR]: 0.2–16.5), median weight: 12.85 kg (IQR: 4.2–67.2). 29 patients (80.5%) received a left ventricular assist device. Four patients (11.1%) had single-ventricle physiology (two patients with bidirectional Glenn anastomosis and two patients with total cavo-pulmonary connection). Two patients (5.5%) had mechanical mitral valve prosthesis.

Results: The median support time was 96.5 days (IQR: 4–619), with 4,980 days of cardiac support. 22 patients (61.1%) were transplanted, eight patients (22.2%) recovered, three patients (8.3%) are on support and three patients (8,3%) died on support. Survival rate was 91.7%. 21 blood pumps had been changed. Four patients (11.1%) had local signs of infection but there was no mediastinitis. Four patients (11.1%) had neurological complication but only one of them needed neurological rehabilitation. From the four patients with single-ventricle physiology, three of them have been transplanted and one patient is on device. There was no death after heart transplantation or after weaning from device.

Conclusion: Excellent survival and a low rate of adverse events are possible after long term mechanical circulatory support with Berlin Heart EXCOR system in patients with single- and two-ventricle physiology. Early implantation decreases the need for right ventricular mechanical support. Prolonged mechanical circulatory support increases the chance for weaning in an era with dramatic organ shortage in young patients with signs of myocardial recovery while on device.