title: Management of pediatric patients after implantation of the Berlin Heart EXCOR ventricular assist device.
abstract: Within the last 16 years, the Berlin Heart EXCOR systems have been used for circulatory support in 73 infants and children up to 17 years of age (mean, 7 years) with severe circulatory failure resistant to pharmacological therapy at our institution. These were patients with cardiomyopathy, fulminant myocarditis, end-stage congenital cardiac defects, and acute heart failure after congenital heart surgery. Mean EXCOR support time was 36 days (range, 1 to 420 days). Forty-four patients (62%) survived up to transplantation or after weaning and 37 (51%) of them, including 9 infants, were discharged home. These results in patients with very advanced disease have improved significantly during the past few years as the result of technical developments and growing experience in the treatment of patients on the device and in postoperative care. The following article gives answers to five questions frequently asked about intensive care unit treatment while on the device, anticoagulation and additional medical support during left ventricular or biventricular support, the daily treatment of the children, and options for the weaning procedure.
authors.affiliation: Department of Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Stiller
authors.forename: Julia
authors.initials: J
authors.lastname: Lemmer
authors.forename: Stephan
authors.initials: S
authors.lastname: Schubert
authors.forename: Peter
authors.initials: P
authors.lastname: Ewert
authors.forename: Ingram
authors.initials: I
authors.lastname: Schulze-Neick
authors.forename: Michael
authors.initials: M
authors.lastname: Hübler
authors.forename: Matthias
authors.initials: M
authors.lastname: Redlin
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001458:Bandages; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods; D003657:Decision Making; D004750:Enteral Nutrition; D004921:Erythropoietin / Q000627:therapeutic use; D005293:Ferritins / Q000627:therapeutic use; D006331:Heart Diseases / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D011182:Postoperative Care / Q000379:methods* / Q000451:nursing
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D004921:Erythropoietin; D005293:Ferritins