title: Preliminary single center North American experience with the Berlin Heart pediatric EXCOR device.
abstract: For children requiring mechanical circulatory support as a bridge to cardiac transplantation in North America, options previously were limited to extracorporeal membrane oxygenation (ECMO) or centrifugal pump ventricular assist, both of which were suitable for only very short term application and were associated with significant complications and limitations. The Berlin Heart EXCOR ventricular assist device (VAD) was recently introduced into practice in North America to address this deficiency. We report a preliminary single center experience with the EXCOR in 17 children, 13 who received only a left-sided pump and four who required biventricular support. Before EXCOR placement, six patients were on ECMO, and one was on a centrifugal VAD. Eleven children were bridged to transplantation, one was bridged to recovery, and one remains on support. Three children died during support and one died after explantation. There was one late death nearly 2 years after transplant. Complications included stroke in seven patients, two of which were ultimately fatal. Five patients required re-operations for bleeding or evacuation of hematoma. Despite a disappointing rate of neurologic morbidity, our preliminary experience with the EXCOR has been very encouraging.
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Arkansas Children's Hospital and University of Arkansas for Health Sciences, Little Rock, Arkansas, USA.
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Rockett
authors.forename: Janet C
authors.initials: JC
authors.lastname: Bryant
authors.forename: W Robert
authors.initials: WR
authors.lastname: Morrow
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Frazier
authors.forename: William P
authors.initials: WP
authors.lastname: Fiser
authors.forename: Wesley A
authors.initials: WA
authors.lastname: McKamie
authors.forename: Charles E
authors.initials: CE
authors.lastname: Johnson
authors.forename: Carl W
authors.initials: CW
authors.lastname: Chipman
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
authors.forename: Robert D B
authors.initials: RD
authors.lastname: Jaquiss
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D000990:Antithrombin III / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000601:surgery; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D009656:North America; D011182:Postoperative Care; D011474:Prosthesis Design; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D000990:Antithrombin III; D006493:Heparin