Role of paediatric assist device in bridge to transplant

Hetzer, Roland; Mfdm, Javier; Em, Delmo Walter

doi:10.21037/acs.2018.01.03

Cited by 21 publications

(31 citation statements)

References 47 publications

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“…In pediatric populations, ECMO is used for organ support in cases of respiratory failure, cardiac failure, and as an adjunct to cardiopulmonary resuscitation (E-CPR) during cardiac arrest [3][4][5][6]. ECMO can also serve as a bridge to selected medical or surgical therapies, including ventricular assist device (VAD), and heart or lung transplant [7,8].…”

Section: Introductionmentioning

confidence: 99%

Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

Fernando¹,

Qureshi²,

Tanuseputro³

et al. 2020

Crit Care

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Background: Extracorporeal membrane oxygenation (ECMO) is used to provide temporary cardiorespiratory support to critically ill children. While short-term outcomes and costs have been evaluated in this population, less is known regarding long-term survival and costs. Methods: Population-based cohort study from Ontario, Canada (October 1, 2009 to March 31, 2017), of pediatric patients (< 18 years of age) receiving ECMO, identified through the use of an ECMO procedural code. Outcomes were identified through linkage to provincial health databases. Primary outcome was survival, measured to hospital discharge, as well as at 1 year, 2 years, and 5 years following ECMO initiation. We evaluated total patient costs in the first year following ECMO. Results: We analyzed 342 pediatric patients. Mean age at ECMO initiation was 2.9 years (standard deviation [SD] = 5.0). Median time from hospital admission to ECMO initiation was 5 days (interquartile range [IQR] = 1-13 days). Overall survival to hospital discharge was 56.4%.

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Section: Introductionmentioning

confidence: 99%

Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

Fernando¹,

Qureshi²,

Tanuseputro³

et al. 2020

Crit Care

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“…Of note, most of these patients had experienced sudden major cardiac events (ie, cardiac arrest or ECMO) before VAD implantation, which may have increased the risk of postoperative neurological morbidity. Therefore, a proactive VAD implant approach is recommended to avoid hemodynamic instability that can cause these fearsome AEs 8‐11 . Lastly, complex CHD was the most frequent cause of MCS with BH, which in our series was associated with worse survival (Figure 5).…”

Section: Discussionmentioning

confidence: 70%

“…To improve outcomes, or even avoid HT, alternative surgical strategies have been developed. Mechanical circulatory support (MCS) with a ventricular assist device (VAD) is an effective strategy in children as a bridge to HT, recovery, or rarely destination therapy 7‐24 . The extracorporeal Berlin Heart EXCOR (BH) can currently provide effective support even in neonates and infants, 17,18,20,21 whereas intracorporeal VAD is reported to have excellent long‐term results in older children or teenagers 22 .…”

Section: Introductionmentioning

confidence: 99%

Surgical strategies for the management of end‐stage heart failure in infants and children: A 15‐year experience with a patient‐tailored approach

et al. 2021

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End‐stage heart failure (ESHF) in pediatric age is an ongoing challenge. Heart transplantation is the final option, but its long‐term outcomes are still suboptimal in children. An alternative patient‐tailored surgical protocol to manage ESHF in children is described. Retrospective, single‐center analysis of pediatric patients admitted to our institution between April 2004 and February 2021 for ESHF. Our current protocol is as follows: (a) Patients <1 year with isolated left ventricular dysfunction due to dilated cardiomyopathy underwent pulmonary artery banding (PAB). (b) Patients <10 years and <20 kg, who did not meet previous criteria were managed with Berlin Heart EXCOR. (c) Patients >10 years or >20 kg, underwent placement of intracorporeal Heartware. Primary outcomes were survival, transplant incidence, and postoperative adverse events. A total of 24 patients (mean age 5.3 ± 5.9 years) underwent 26 procedures: PAB in 6 patients, Berlin Heart in 11, and Heartware in 7. Two patients shifted from PAB to Berlin Heart. Overall survival at 1‐year follow‐up and 5‐year follow‐up was 78.7% (95%CI = 62%‐95.4%) and 74.1% (95%CI = 56.1%‐92.1%), respectively. Berlin Heart was adopted in higher‐risk settings showing inferior outcomes, whereas a PAB enabled 67% of patients to avoid transplantation, with no mortality. An integrated, patient‐tailored surgical strategy, comprehensive of PAB and different types of ventricular assist devices, can provide satisfactory medium‐term results for bridging to transplant or recovery. The early postoperative period is critical and requires strict clinical vigilance. Selected infants can benefit from PAB that has demonstrated to be a safe bridge to recovery.

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“… 5 However, due to the fact that they are designed and optimized for high flow rates, in the case of small children (weight ⩽ 20 kg), pulsatile devices are still used predominantly. 5 – 7 Engineers apply state-of-the-art methods to make the flow in the pulsatile VAD more efficient. 8 – 13 As far as the device operation is concerned, the phenomena of coagulation, activation of platelets, haemolysis and cavitation, which may occur in the device, are the most important.…”

Section: Introductionmentioning

confidence: 99%

Methods for determination of stagnation in pneumatic ventricular assist devices

et al. 2018

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Background:A pneumatic paediatric ventricular assist device developed at the Foundation of Cardiac Surgery Development, Zabrze, equipped with valves based on J. Moll’s design, with later modifications introduced at the Institute of Turbomachinery, Lodz University of Technology, was tested numerically and experimentally. The main aim of those investigations was to detect stagnation zones within the ventricular assist device and indicate advantages and limitations of both approaches.Methods:In the numerical transient test, a motion of the diaphragm and discs was simulated. Two different methods were used to illustrate stagnation zones in the ventricular assist device. The flow pattern inside the chamber was represented by velocity contours and vectors to validate the results using images obtained in the laser particle image velocimetry experiment.Results:The experimental light-based method implied problems with proper illumination of regions in the wall vicinity. High-resolution flow data and other important parameters as stagnation regions or flow patterns in regions not accessible for light in the particle image velocimetry method are derived in the numerical solution. However, computations of a single case are much more time-consuming if compared to a single experiment conducted on a well-calibrated stand.Conclusion:The resulting main vortexes in the central part of the pump chamber and the velocity magnitudes are correlated in both methods, which are complementary and when used together offer better insight into the flow structure inside the ventricular assist device and enable a deeper analysis of the results.

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Role of paediatric assist device in bridge to transplant

Cited by 21 publications

References 47 publications

Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

Surgical strategies for the management of end‐stage heart failure in infants and children: A 15‐year experience with a patient‐tailored approach

Methods for determination of stagnation in pneumatic ventricular assist devices

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