title: Surgical therapy of end-stage heart failure in pediatric patients.
abstract: OBJECTIVE
  We herein review our experience with ventricular assist device (VAD) implantation and heart transplantation in children with end-stage heart failure.
  
  
  METHODS
  We performed a retrospective nonrandomized review of all patients who underwent insertion of a Berlin Heart Excor VAD or heart transplantation in our clinic. The study spans from July 2005 to July 2010. We transplanted 11 patients of mean age 11.8 ± 4.49 years, 3 of whom with critical hemodynamic situations were bridged to heart transplantation by VAD implantation. Despite the poor right ventricular systolic functions, they did not require right rVAD. In addition, 2 patients who underwent VAD implantation are still awaiting a donor heart. The mean follow-up was 825.27 ± 630.23 days (range, 21-1,888 days).
  
  
  RESULTS
  There was no serious complication during VAD support. The overall heart transplantation mortality rate was 9.1% (1/11). In all patients, impaired end-organ functions were improved by VAD implantation before the heart transplantation. Cardiac biopsies revealed 4 grade 2R rejection episodes, which were successfully controlled in 3 patients.
  
  
  CONCLUSIONS
  Heart transplantation is highly effective therapy for pediatric patients with end-stage heart failure. Pediatric VAD implantation provided satisfactory safe circulatory support for small children in poor condition on the waiting list. This option should be considered for all pediatric candidates who show a poor hemodynamic status.
authors.affiliation: Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Ayik
authors.forename: E
authors.initials: E
authors.lastname: Oguz
authors.forename: C
authors.initials: C
authors.lastname: Engin
authors.forename: T
authors.initials: T
authors.lastname: Yagdi
authors.forename: Z
authors.initials: Z
authors.lastname: Ulger
authors.forename: Y
authors.initials: Y
authors.lastname: Atay
authors.forename: M
authors.initials: M
authors.lastname: Ozbaran
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006084:Graft Rejection; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D012189:Retrospective Studies