The pediatric mechanical circulatory support program in Innsbruck, Austria, and the impact of such programs on lack of donor hearts in Europe.
Strategy and results of the Innsbruck Mechanical Circulatory Support Program are presented, and the impact of such programs on pediatric heart transplantation (HTX) in Europe is discussed. Venoarterial extracorporeal membrane oxygenation (vaECMO) and ventricular assist devices (VADs) were used in 21 pediatric patients (median age 3.3 years, 2 days to 17 years) for acute heart failure (AHF) following a bridge or bridge-to-bridge strategy. Twelve patients were treated with vaECMO: eight were weaned after 2-10 days, two died, and two were switched to a VAD. Of the last, one was weaned 47 days later and the other underwent HTX 168 days later. In nine patients, VAD was implanted without preceding vaECMO. One such patient died (cerebral hemorrhage) after 236 days; of the remaining eight patients three were weaned and five underwent HTX. Waiting time for HTX (high-urgency status) varied from 4 to 372 days. Fifteen patients were discharged (follow up: 2-74 months); 14 are doing very well (New York Heart Association (NYHA) Functional Classification Class I, neurologically normal), whereas one suffers from severe neurologic damage, presumably from resuscitation before vaECMO. Data from Eurotransplant on pediatric HTX in 2004, 2005, and 2006 (33, 49, and 34 transplanted hearts, respectively; recipients <16 years of age) are discussed. Mechanical circulatory support (MCS) substantially improves survival with AHF in pediatric patients. Medium-term support (up to 400 days in our patients) is possible and outcome of survivors is excellent. Wide spread use of MCS might slightly aggravate the lack of donor organs, which could result in longer support times.
Department of Pediatrics III-Pediatric Cardiology, Innsbruck Medical University, Innsbruck, Austria.
Ulrich
U
Schweigmann
Herwig
H
Antretter
Peter
P
Mair
Corinna
C
Velik-Salchner
Josef
J
Margreiter
Jorrit
J
Brunnemann
Elisabeth
E
Schermer
Georg
G
Engl
Christoph
C
Hoermann
Daniel
D
Hoefer
Juliane
J
Kilo
Guenther
G
Laufer
Joerg-Ingolf
JI
Stein
Ralf
R
Geiger
Axel
A
Rahmel
Marjan
M
Slot
Marco
M
Cottogni
D000208:Acute Disease; D001317:Austria; D002675:Child, Preschool; D005060:Europe; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014850:Waiting Lists