Objectives Our study objective was to analyse adverse events in adolescent and adult Berlin Heart EXCOR patients and to assess outcome of subsequent heart transplantation (HTX) Methods From 2006 to 2020, 58 patients (12–64 years) received a biventricular assist device (BIVAD) at our institution and were included in this study. Results Causes of biventricular heart failure were non-ischaemic cardiomyopathy (62.1%), ischaemic cardiomyopathy (22.4%) and myocarditis (15.5%). Median INTERMACS score was I (I—III). Median age was 49 years (IQR 34–55 years) and 82.8% were male. Causes of death were: multi-organ failure (25.0%), septic shock (17.9%), cerebral haemorrhage (14.3%), bleeding (14.3%) and embolic events (14.3%). Major bleedings were more frequent in the group who died on BIVAD (60.7 vs 6.7%, p < 0.001). Wound infections were more prevalent in HTX recipients (n = 21, 70.0%). After BIVAD thrombosis, 104 chamber exchanges were performed in 28 patients (48.3%). HTX was performed in 52.6% of the patients after BIVAD support time 316 ± 240 days. Mean time to follow-up of 30 HTX recipients was 1722 ± 1368 days. One-, 6- and 12-month-survival after heart transplantation were 96.7%, 90.0% and 76.7% respectively. Long-term survival after 5 and 10 years was 69.7%. Conclusions Pump thrombosis, infections and bleeding after BIVAD did not preclude successful HTX. Although only 50% of BIVAD patients were successfully transplanted, long-term survival after HTX in BIVAD patients was non-inferior when compared to other recipients.
The Berlin Heart® EXCOR is a paracorporeal, pulsatile ventricular assist device used in patients of all age groups. However, adolescent and adult patients on EXCOR support are scarcely explored. Herein, we present a detailed description of infectious complications in this patient cohort. From 2006 to 2020, 58 patients received a biventricular assist device (BiVAD) at our institution and were included in this study. Postoperative infections were assessed after BiVAD implantation and subsequent heart transplantation (HTx). A Berlin Heart® EXCOR BiVAD was implanted as a bridge to transplantation in 58 patients (12–64 years). Most patients were INTERMACS I, and their median age was 49 years. Wound infections (WI) specific to the ventricular assist device (VAD) occurred in 31 (53.4%) patients with a mean time of 113 ± 155 days after BiVAD implantation. HTx was performed in 30 (51.7%) patients and thereof 10 (33.3%) patients developed at least one WI post-HTx. The mean time of WI after HTx was 17 ± 14 days. In four cases, WIs were caused by the same pathogen as before HTx. According to our institutional BiVAD wound classification, the mean wound score was 3. The VAD-specific wound infections were manageable and did not increase mortality nor precluded HTx in Berlin Heart® EXCOR patients. No specific risk factors for VAD-specific wound infections could be identified.
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