The National Heart, Lung, and Blood Institute Pediatric Circulatory Support Program

Baldwin, J. Timothy; Borovetz, Harvey S.; Duncan, Brian W.; Gartner, Mark; Jarvik, Robert; Weiss, Jason; Hoke, Tracey R.

doi:10.1161/circulationaha.105.571422

Cited by 183 publications

(112 citation statements)

References 33 publications

(22 reference statements)

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“…The relatively rapid adoption of this technology by >45 centers in the United States and Canada in a relatively short time frame likely stems from widespread appreciation of the unacceptably high waiting-list mortality in US infants and children with or without ECMO, 1,31,32 the lack of alternative devices, the favorable German EXCOR experience, 6,25 and a foundational shift in the willingness of US clinicians to use emerging circulatory support technologies that were used variably in Germany as early as the mid1990s. 3,[33][34][35][36][37] This fundamental change in US clinical practice represents a major milestone for the field of pediatric heart failure therapy. With a growing number of novel miniaturized pediatric VADs now on the horizon, [38][39][40] FDA approval of the EXCOR marks the beginning of a new era in pediatric mechanical circulatory support.…”

Section: Downloaded Frommentioning

confidence: 99%

Berlin Heart EXCOR Pediatric Ventricular Assist Device for Bridge to Heart Transplantation in US Children

et al. 2013

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Background— Recent data suggest that the Berlin Heart EXCOR Pediatric ventricular assist device is superior to extracorporeal membrane oxygenation for bridge to heart transplantation. Published data are limited to 1 in 4 children who received the device as part of the US clinical trial. We analyzed outcomes for all US children who received the EXCOR to characterize device outcomes in an unselected cohort and to identify risk factors for mortality to facilitate patient selection. Methods and Results— This multicenter, prospective cohort study involved all children implanted with the Berlin Heart EXCOR Pediatric ventricular assist device at 47 centers from May 2007 through December 2010. Multiphase nonproportional hazards modeling was used to identify risk factors for early (<2 months) and late mortality. Of 204 children supported with the EXCOR, the median duration of support was 40 days (range, 1–435 days). Survival at 12 months was 75%, including 64% who reached transplantation, 6% who recovered, and 5% who were alive on the device. Multivariable analysis identified lower weight, biventricular assist device support, and elevated bilirubin as risk factors for early mortality and bilirubin extremes and renal dysfunction as risk factors for late mortality. Neurological dysfunction occurred in 29% and was the leading cause of death. Conclusions— Use of the Berlin Heart EXCOR has risen dramatically over the past decade. The EXCOR has emerged as a new treatment standard in the United States for pediatric bridge to transplantation. Three-quarters of children survived to transplantation or recovery; an important fraction experienced neurological dysfunction. Smaller patient size, renal dysfunction, hepatic dysfunction, and biventricular assist device use were associated with mortality, whereas extracorporeal membrane oxygenation before implantation and congenital heart disease were not.

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Section: Downloaded Frommentioning

confidence: 99%

Berlin Heart EXCOR Pediatric Ventricular Assist Device for Bridge to Heart Transplantation in US Children

et al. 2013

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“…Easily adaptable, the MIP could have a great use as a pediatric pump. 20 It implemented on a graft for children suffering of an underdeveloped heart that have undergone a Fontan procedure. 21,22 The pump can be as simple as a gelatin coated graft enliven by a pincher.…”

Section: -9mentioning

confidence: 99%

Resonant pumping in a multilayer impedance pump

2008

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This paper introduces the concept of multilayer impedance pump, a novel pumping mechanism inspired by the embryonic heart structure. The pump is a composite two-layer fluid-filled elastic tube featuring a thick gelatinous internal. Pumping is based on the impedance pumping mechanism. In an impedance pump, elastic waves are generated upon external periodic compressions of the elastic tube. These waves propagate along the tube's walls, reflect at the tube's extremities, and drive the flow in a preferential direction. The originality in the multilayer impedance pump design relies on the use of the thick internal gelatinous layer to amplify the elastic waves responsible for the pumping. As a consequence, only small excitations are needed to produce significant flow. This fully coupled fluid-structure interaction problem is solved for the flow and the structure using the finite element method over a relevant range of frequencies of excitation. Results show that the multilayer impedance pump is a complex system that exhibits a resonant response. Flow output and inner wall motion are maximal when the pump is actuated at the resonant frequency. The wave interaction mechanism present in an impedance pump is described here in details for the case of a multilayer impedance pump. Using energy balance for the passive portion of the elastic tube, we show that the elastic tube itself works as a pump and that at resonance maximum energy transmission between the elastic tube and the fluid occurs. Finally, the pump is especially suitable for many biomedical applications.

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“…The presence of robust outcome data is essential for measuring patient outcomes, reviewing the emerging field of pediatric mechanical circulatory support, and evaluating novel pediatricspecific devices. 25 INTERMACS analyses are evaluated in light of single-institution studies and published results of FDA IDE trials, both of which appear before publications from INTERMACS because INTERMACS is limited to data from FDA-approved MCSDs.…”

Section: Intermacs: Accomplishments To Datementioning

confidence: 99%

Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)

Holman

2012

Circulation

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The National Heart, Lung, and Blood Institute Pediatric Circulatory Support Program

Cited by 183 publications

References 33 publications

Berlin Heart EXCOR Pediatric Ventricular Assist Device for Bridge to Heart Transplantation in US Children

Berlin Heart EXCOR Pediatric Ventricular Assist Device for Bridge to Heart Transplantation in US Children

Resonant pumping in a multilayer impedance pump

Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)

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