title: Use of assist devices and ECMO to bridge pediatric patients with cardiomyopathy to transplantation.
abstract: 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.
authors.affiliation: Division of Pediatric Cardiology, UCLA Center for Health Sciences, University of California, Los Angeles, California 90095-1741, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Levi
authors.forename: Daniel
authors.initials: D
authors.lastname: Marelli
authors.forename: Mark
authors.initials: M
authors.lastname: Plunkett
authors.forename: Juan
authors.initials: J
authors.lastname: Alejos
authors.forename: Jessica
authors.initials: J
authors.lastname: Bresson
authors.forename: Julie
authors.initials: J
authors.lastname: Tran
authors.forename: Christian
authors.initials: C
authors.lastname: Eisenring
authors.forename: Ali
authors.initials: A
authors.lastname: Sadeghi
authors.forename: Alvaro
authors.initials: A
authors.lastname: Galindo
authors.forename: Daniel
authors.initials: D
authors.lastname: Fazio
authors.forename: Anuja
authors.initials: A
authors.lastname: Gupta
authors.forename: Caron
authors.initials: C
authors.lastname: Burch
authors.forename: Barbara
authors.initials: B
authors.lastname: George
authors.forename: Hillel
authors.initials: H
authors.lastname: Laks
mesh_terms: 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