title: A decade of pediatric mechanical circulatory support before and after cardiac transplantation.
abstract: OBJECTIVE
  We reviewed the use of pediatric mechanical circulatory support before and after transplantation to examinine current results and future strategies.
  
  
  METHODS
  All patients listed for transplantation from January 2000 to December 2010 who required either extracorporeal membrane oxygenation (ECMO) or ventricular assist device (VAD) support before ("intention to transplant") or after transplantation were included. Indications for mechanical assistance, age, weight, duration of support, complications while on support, causes of death, and overall actuarial survival were recorded.
  
  
  RESULTS
  Thirty-seven patients were received VADs; 32 (86.5%) survived to transplantation. Postoperative hemorrhagic or thrombotic complications affected all of those under 15 kg. One patient in the survivor cohort demonstrated focal neurologic findings. Three (8.1%) had panel reactive antibody levels of 10% or more while on device support; all received transplants. ECMO as an intention to bridge to transplantation was used in 28 patients; 7 died, 7 were weaned, and 14 were bridged to transplantation. Nineteen patients required ECMO after transplantation; 3 additional patients had percutaneous VAD support for late rejection. There was a significant (P = .02) difference in survival after listing for transplantation among those supported with ECMO, with VAD, and those not supported with a device. No difference in posttransplant survival was demonstrated between those patients supported with either ECMO or VAD before transplant compared with all others not bridged to transplantation.
  
  
  CONCLUSIONS
  Both VAD and ECMO support are highly effective means of bridging patients to transplantation and supporting patients after transplanatation. Ideally, the availability of smaller devices for children will have a favorable impact on the morbidity related to anticoagulation in the smallest patients.
authors.affiliation: Weill Medical College of Cornell University, New York, NY, USA. Jmc23@columbia.edu
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Chen
authors.forename: Marc E
authors.initials: ME
authors.lastname: Richmond
authors.forename: Kevin
authors.initials: K
authors.lastname: Charette
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Mathew
authors.initials: M
authors.lastname: Williams
authors.forename: Lisa
authors.initials: L
authors.lastname: Gilmore
authors.forename: Alejandro
authors.initials: A
authors.lastname: Garcia
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Addonizio
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D009519:New York City; D018579:Patient Selection; D011182:Postoperative Care; D011300:Preoperative Care; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D000925:Anticoagulants