Bridge to Cardiac Transplant in Children: Berlin Heart versus Extracorporeal Membrane Oxygenation

Imamura, Michiaki; Dossey, Amy M.; Prodhan, Parthak; Schmitz, Michael L.; Frazier, Elizabeth A.; Dyamenahalli, Umesh; Bhutta, Adnan T.; Morrow, W. Robert; Jaquiss, Robert D.B.

doi:10.1016/j.athoracsur.2009.03.049

Cited by 92 publications

(53 citation statements)

References 19 publications

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“…[101][102][103][104][105][106][107][108][109][110][111][112][113] Neurological events (eg, thromboembolism, hemorrhage) may occur when patients are placed on extracorporeal membrane oxygenation or ventricular assist devices with or without subsequent heart transplantation. 102,104,107,109 Developmental delays and disabilities after heart transplantation include delays in motor development, speech/language acquisition, and abstract reasoning/goaldirected behaviors 110 and impairments in IQ, 111 expressive language, 111 visual-motor skills, 111 fine motor skills, 111 psychosocial functioning, 112 and psychomotor scores. 113 …”

Section: Mechanical Support or Heart Transplantationmentioning

confidence: 99%

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

Marino¹,

Lipkin²,

Newburger³

et al. 2012

Circulation

1,249

1,156

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Background— The goal of this statement was to review the available literature on surveillance, screening, evaluation, and management strategies and put forward a scientific statement that would comprehensively review the literature and create recommendations to optimize neurodevelopmental outcome in the pediatric congenital heart disease (CHD) population. Methods and Results— A writing group appointed by the American Heart Association and American Academy of Pediatrics reviewed the available literature addressing developmental disorder and disability and developmental delay in the CHD population, with specific attention given to surveillance, screening, evaluation, and management strategies. MEDLINE and Google Scholar database searches from 1966 to 2011 were performed for English-language articles cross-referencing CHD with pertinent search terms. The reference lists of identified articles were also searched. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. A management algorithm was devised that stratified children with CHD on the basis of established risk factors. For those deemed to be at high risk for developmental disorder or disabilities or for developmental delay, formal, periodic developmental and medical evaluations are recommended. A CHD algorithm for surveillance, screening, evaluation, reevaluation, and management of developmental disorder or disability has been constructed to serve as a supplement to the 2006 American Academy of Pediatrics statement on developmental surveillance and screening. The proposed algorithm is designed to be carried out within the context of the medical home. This scientific statement is meant for medical providers within the medical home who care for patients with CHD. Conclusions— Children with CHD are at increased risk of developmental disorder or disabilities or developmental delay. Periodic developmental surveillance, screening, evaluation, and reevaluation throughout childhood may enhance identification of significant deficits, allowing for appropriate therapies and education to enhance later academic, behavioral, psychosocial, and adaptive functioning.

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Section: Mechanical Support or Heart Transplantationmentioning

confidence: 99%

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

Marino¹,

Lipkin²,

Newburger³

et al. 2012

Circulation

1,249

1,156

View full text Add to dashboard Cite

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“…What they found was that survival to transplant and recovery was significantly higher in the EXCOR subgroup versus the ECMO group (86% versus 57%). Despite this excellent result, 40% of the patients sustained neurologic injury [14].…”

Section: Bridge To Cardiac Transplantation or Re-transplantationmentioning

confidence: 99%

Current Use of the EXCOR Pediatric Ventricular Assist Device

Bryant

Steiner

Louis

2010

J. of Cardiovasc. Trans. Res.

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Since its initial application in the pediatric patient population, the Berlin Heart EXCOR ventricular assist device has become a widely accepted form of mechanical circulatory support in Europe and the USA. The versatility of the device makes it ideal for pediatric patients because it can be tailored to the size and needs of the patient. In this review, we will explore the broad range of clinical applications of this device including bridge to cardiac transplantation, bridge to recovery, and bridge to bridge implantation where the need for cardiac transplantation may be unclear but long-term mechanical support may be required.

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“…It is employed to allow for myocardial recovery, support until a reparative operation can be performed or (more recently) as a bridge to a VAD, and potentially as a bridge to decision. ECMO, however, is hampered by a significant complication rate that increases with the duration of support (6,7). Currently, VADs have been increasingly utilized in many pediatric situations (8)(9)(10)(11)(12)(13).…”

Section: Review Articlementioning

confidence: 99%

“…It does, however, have a significant risk profile, with a serious risk of adverse events with any significant duration. Due to these attributes it is ideally suited for emergencies or support that is anticipated to be of short duration (6,7). Limitations of ECMO stem in part from the typical required approach: peripheral cannulation generally limits flow rates (in contrast to central cannulation) due to vessel size, increased surface exposure from long segments of an intravascular cannula (and hence greater chance for activation of clotting cascades as well as the need for anticoagulation), and inherent limitations of mobility and rehabilitation potential related to concerns with cannula dislodgment.…”

Section: Device Typementioning

confidence: 99%

An overview of mechanical circulatory support in single-ventricle patients

et al. 2018

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The population of people with a single-ventricle is continually increasing due to improvements across the spectrum of medical care. Unfortunately, a proportion of these patients will develop heart failure.Often, for these patients, mechanical circulatory support (MCS) represents the only available treatment option. While single-ventricle patients currently represent a small proportion of the total number of patients who receive MCS, as the single-ventricle patient population increases, this number will increase as well.Outcomes for these complex single-ventricle patients who require MCS has begun to be evaluated. When considering the entire population, survival to hospital discharge is 30-50%, though this must be considered with the significant heterogeneity of the single-ventricle patient population. Patients with a single-ventricle have unique anatomy, mechanisms of failure, indications for MCS and the type of support utilized. This has made the interpretation and the generalizability of the limited available data difficult. It is likely that some subsets will have a significantly worse prognosis and others a better one. Unfortunately, with these limited data, indications of a favorable or poor outcome have not yet been elucidated. Though currently, a database has been constructed to address this issue. While the outcomes for these complex patients is unclear, at least in some situations, they are poor. However, significant advances may provide improvements going forward, including new devices, computer simulations and 3D printed models. The most important factor, however, will be the increased experience gained by the heart failure team to improve patient selection, timing, device and configuration selection and operative approach.

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Bridge to Cardiac Transplant in Children: Berlin Heart versus Extracorporeal Membrane Oxygenation

Cited by 92 publications

References 19 publications

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

Current Use of the EXCOR Pediatric Ventricular Assist Device

An overview of mechanical circulatory support in single-ventricle patients

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