Use of assist devices and ECMO to bridge pediatric patients with cardiomyopathy to transplantation.
BACKGROUND
Pulsatile ventricular assist devices (VADs) are used to bridge adults with end-stage heart disease to transplantation. A combination of external implantable pulsatile and continuous-flow external mechanical support now can be used to bridge pediatric patients with end-stage cardiomyopathy to orthotopic heart transplantation (OHT).


METHODS
We reviewed consecutive pediatric patients with cardiomyopathy (n = 28) who required mechanical cardiac support from July 1995 to February 2001. All were OHT candidates with severe hemodynamic compromise despite maximal medical support. We excluded from this series patients who had undergone cardiotomy.


RESULTS
Nineteen patients received support from external continuous-flow devices, either with extracorporeal membrane oxygenation or with centrifugal VADs, and 9 patients received pulsatile support. Nineteen of 28 (68%) patients were successfully bridged to transplant (17) or weaned (2) from their devices after recovery. Of the patients successfully bridged to transplant or recovery, 89% are alive to date. Univariate analysis revealed that a lower bilirubin concentration after 2 days of support was associated with a favorable outcome (p = 0.006). As expected, the patients with pulsatile VADs had significantly higher rates of extubation and oral feeding.


CONCLUSIONS
Pulsatile and continuous-flow devices can complement each other to significantly extend the lives of a wide range of pediatric patients with severe cardiomyopathies.
Levi
Daniel
D
Division of Pediatric Cardiology, UCLA Center for Health Sciences, University of California, Los Angeles, California 90095-1741, USA.
Marelli
Daniel
D
Plunkett
Mark
M
Alejos
Juan
J
Bresson
Jessica
J
Tran
Julie
J
Eisenring
Christian
C
Sadeghi
Ali
A
Galindo
Alvaro
A
Fazio
Daniel
D
Gupta
Anuja
A
Burch
Caron
C
George
Barbara
B
Laks
Hillel
H
D000293:Adolescent; D009202:Cardiomyopathies / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome