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The Berlin Heart EXCOR Pediatrics—The SickKids Experience 2004–2008

机译：柏林心脏EXCOR儿科—病童经历2004–2008

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The ventricular assist device (VAD) Berlin Heart EXCOR Pediatrics was utilized at our institution since 2004 for bridging pediatric patients to cardiac transplantation or myocardial recovery. The present study reviewed our results following VAD implantation. We retrospectively reviewed patients that underwent implantation of a VAD between October 2004 and October 2008. Data collected included age at implantation, gender, weight, underlying disease, pre- and postdevice clinical status, complications, and outcome. Fifteen patients were identified (9 female and 6 male, average age: 8.8 years, range 0.3–14.8; average weight 31.1 kg, range 5.2–86.4). Indications for VAD support were dilated cardiomyopathy in 14 patients and progressing heart failure with a single ventricle physiology (bidirectional Glenn shunt) in one patient. Three patients (20%) were bridged from extracorporeal membrane oxygenation to VAD. Average support was 29 (1–108) days. Fourteen patients were on a bi-VAD, one patient (single ventricle) had single VAD support. Three patients developed mediastinal/pericardial fluid collections, requiring surgical exploration in two, and drain insertion in one. Three patients presented with neurological symptoms. In two patients, a total of three blood pumps were exchanged due to thrombus formation. No patient was weaned off the VAD; two patients (13%) died on the VAD. All surviving patients are neurologically intact at follow-up. In our experience, VAD support provides an effective means of bridging children with advanced dilated cardiomyopathy or heart failure to transplantation with a relatively small number of complications and deaths given the complexity of the patient population.
机译：自2004年以来，我们的机构就一直使用心室辅助设备（VAD）柏林心脏EXCOR儿科将儿科患者桥接到心脏移植或心肌恢复中。本研究回顾了我们在VAD植入后的结果。我们回顾性分析了2004年10月至2008年10月间接受VAD植入的患者。收集的数据包括植入时的年龄，性别，体重，潜在疾病，器械前后的临床状况，并发症和结局。确定了15名患者（9名女性和6名男性，平均年龄：8.8岁，范围0.3–14.8；平均体重31.1 kg，范围5.2–86.4）。 VAD支持的适应症包括14例扩张型心肌病和1例单心室生理学（双向Glenn分流）进展性心力衰竭。三名患者（20％）从体外膜氧合桥接到VAD。平均支持时间为29（1-108）天。 14例患者使用双VAD，其中1例（单心室）采用单VAD支持。三例患者出现了纵隔/心包积液，需要两次进行外科手术探查，一次进行引流。三例患者出现神经系统症状。在两名患者中，由于血栓形成，总共更换了三个血泵。没有患者从VAD断奶。两名患者（13％）死于VAD。所有幸存的患者在随访时神经系统均完整。根据我们的经验，鉴于患者的复杂性，VAD支持提供了一种有效的方法，可以将患有晚期扩张型心肌病或心力衰竭的儿童移植到移植中，而并发症和死亡的发生率相对较低。

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