title: Bridge to cardiac transplant in children: Berlin Heart versus extracorporeal membrane oxygenation.
abstract: BACKGROUND
  For small children requiring mechanical circulatory support as a bridge to transplantation (BTT), extracorporeal membrane oxygenation (ECMO) has been the only option until the recent introduction of the Berlin Heart EXCOR ventricular assist device (Berlin Heart AG, Berlin, Germany). We reviewed our recent experience with these two technologies with particular focus on early outcomes.
  
  
  METHODS
  Data for 55 consecutive children undergoing BTT between 2001 and 2008 were abstracted from an institutional database. The analysis excluded 13 patients because EXCOR was not used for acute postcardiotomy BTT. Patients were divided into ECMO (n = 21) and EXCOR groups (n = 21). Specific end points included survival to transplant, overall survival, and bridge to recovery. Incidences of adverse events and the duration of support were determined.
  
  
  RESULTS
  Groups were similar in weight, age, and etiologies of heart failure. Likewise, the incidences of stroke and multisystem organ failure were similar. Survival to transplant, recovery, or continued support was 57% in ECMO and 86% in EXCOR (p = 0.040). EXCOR patients had overall significantly better survival (p = 0.049). Two ECMO patients and 1 EXOR patient were bridged to recovery. The mean duration of support was 15 +/- 12 days in the ECMO group and 42 +/- 43 days in the EXCOR group (p < 0.001).
  
  
  CONCLUSIONS
  In children requiring BTT, EXCOR provided substantially longer support times than ECMO, without significant increase in the rates of stroke or multisystem organ failure. Survival to transplant and long-term survival was higher with EXCOR.
authors.affiliation: Pediatric Cardiothoracic Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas 72202, USA. imamuramichiaki@uams.edu
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
authors.forename: Amy M
authors.initials: AM
authors.lastname: Dossey
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.forename: Michael
authors.initials: M
authors.lastname: Schmitz
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Frazier
authors.forename: Umesh
authors.initials: U
authors.lastname: Dyamenahalli
authors.forename: Adnan
authors.initials: A
authors.lastname: Bhutta
authors.forename: W Robert
authors.initials: WR
authors.lastname: Morrow
authors.forename: Robert D B
authors.initials: RD
authors.lastname: Jaquiss
mesh_terms: D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies