title: The combined use of extracorporeal life support and the Berlin Heart pulsatile pediatric ventricular assist device as a bridge to transplant in a toddler.
abstract: There is a very limited published material about experience with long-term pediatric mechanical circulatory support as a bridge to heart transplant. We report on a 2-year-old, 12 kg boy admitted with 2-week history of low-grade fever, ear pain, pulmonary edema, and congestive heart failure. Trans-thoracic echocardiography confirmed severe myocardial dysfunction with a left ventricular ejection fraction of 0.20 and percentage shortening of 13. After 2 days of ventilatory and inotropic support, the patient continued to deteriorate and subsequently required femoro-femoral extracorporeal life support (ECLS). This was later complicated by a progressive coagulopathy and massive bleeding. On day 17, a pulsatile pediatric paracorporeal biventricular assist device (VAD) (Berlin Heart) was implanted. The patient's condition improved significantly with all coagulopathies corrected, and the patient was extubated 21 days later. After 109 days of bi-VAD support, the patient was successfully transplanted and discharged home 45 days post transplant. Our early experience with initial ECLS bridge to VAD and subsequently to transplant was encouraging. It allowed for additional time to select the ideal organ donor and optimize the recipient's comorbid condition and multiorgan failure. VAD provides an additional armamentarium of circulatory support in pediatric patients with severe heart failure.
authors.affiliation: Department of Clinical Perfusion, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Laliberté
authors.forename: Renzo
authors.initials: R
authors.lastname: Cecere
authors.forename: Christo
authors.initials: C
authors.lastname: Tchervenkov
authors.forename: Calvin
authors.initials: C
authors.lastname: Wan
authors.forename: Bindu
authors.initials: B
authors.lastname: Bittira
authors.forename: Christos
authors.initials: C
authors.lastname: Calaritis
authors.forename: Marie
authors.initials: M
authors.lastname: Béland
authors.forename: Mary
authors.initials: M
authors.lastname: Decell
authors.forename: Teodoro
authors.initials: T
authors.lastname: Reyes
authors.forename: Dominique
authors.initials: D
authors.lastname: Shum-Tim
mesh_terms: D002675:Child, Preschool; D018450:Disease Progression; D005112:Extracorporeal Circulation / Q000295:instrumentation*; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008021:Life Support Systems; D008297:Male; D011300:Preoperative Care; D013997:Time Factors