title: Changing patterns of bridging to heart transplantation in children.
abstract: BACKGROUND
  Mechanical support as a bridge to cardiac transplantation in children is an accepted treatment. With improved devices and increasing experience, the length of time that children can be supported has increased. Donor organs remain scarce and there is significant associated morbidity.
  
  
  METHODS
  Retrospective review of all children offered mechanical support as a bridge to heart transplant over 10 years in one of the two UK pediatric heart transplant centers. Outcomes during the years 1998 to 2002 were compared with outcomes during the years 2003 to 2007.
  
  
  RESULTS
  Forty children in 41 separate patient episodes received mechanical support as a bridge to transplantation or, in 1 case, to recovery. Survival to transplant or recovery was achieved in 29 of 41 (71%); 26 of 40 children (63%) survived to hospital discharge. Devices used were extracorporeal membrane oxygenation (ECMO), the Medos HIAA, the Berlin Heart (from November 2005) and the Levitronix ventricular assist device (VAD) from 2007. All 3 children supported with the Levitronix survived to transplant (median duration of support 10 days). Ten of 13 children (77%) supported by the Berlin Heart survived to transplant or recovery (median duration of support 44 days). Four of 7 (57%) children supported using the Medos device survived to transplant (median duration of support 7 days). Neurologic events were the most common cause of death in both eras (1998 to 2002 and 2003 to 2008).
  
  
  CONCLUSIONS
  Waiting times to pediatric cardiac transplant in the UK have increased. The Berlin Heart allows children to be bridged to transplant over long periods. Neurologic morbidity remains as a major concern.
authors.affiliation: Freeman Hospital, Newcastle upon Tyne, UK. jane.cassidy@nuth.nhs.uk
authors.forename: Jane
authors.initials: J
authors.lastname: Cassidy
authors.forename: Simon
authors.initials: S
authors.lastname: Haynes
authors.forename: Richard
authors.initials: R
authors.lastname: Kirk
authors.forename: David
authors.initials: D
authors.lastname: Crossland
authors.forename: Jonathan Hayden
authors.initials: JH
authors.lastname: Smith
authors.forename: Leslie
authors.initials: L
authors.lastname: Hamilton
authors.forename: Massimo
authors.initials: M
authors.lastname: Griselli
authors.forename: Asif
authors.initials: A
authors.lastname: Hasan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies