title: Incremental reduction in the incidence of stroke in children supported with the Berlin EXCOR ventricular assist device.
abstract: BACKGROUND
  Cerebrovascular events (CVEs) are common among children supported with the Berlin EXCOR (Berlin Heart GmbH, Berlin, Germany) ventricular assist device (VAD). Given the high incidence of CVEs associated with this device, we sought to describe our institutional experience in incrementally reducing CVEs in children supported with the Berlin EXCOR VAD.
  
  
  METHODS
  We collected pertinent data on 39 consecutive patients who underwent Berlin EXCOR VAD implantation at a single center. Frequency of CVEs was described in risk per implantation, per day, and in reference to the time of therapeutic anticoagulation. Risk factors were analyzed for association with CVEs.
  
  
  RESULTS
  Of the initial 39 Berlin EXCOR VAD implantations, 16 CVEs occurred in 12 patients. The incidence of CVEs decreased with institutional experience per patient (R(2) = 0.6909, p = 0.007) and per patient-day (R(2) = 0.8051, p = 0.002). CVEs occurred more frequently before therapeutic anticoagulation targets were achieved (4.1%/day) compared with after therapeutic anticoagulation targets were achieved (0.9%/day; p = 0.044).
  
  
  CONCLUSIONS
  Incidence of CVEs decreased with institutional experience. The risk of CVE is highest in the immediate postoperative period before therapeutic anticoagulation is achieved. Further studies are warranted in pediatric patients supported with the Berlin EXCOR VAD to confirm our findings in a larger cohort.
authors.affiliation: Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, Arkansas. Electronic address: jonathanwbyrnes@gmail.com.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Byrnes
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.forename: Blake A
authors.initials: BA
authors.lastname: Williams
authors.forename: Michael L
authors.initials: ML
authors.lastname: Schmitz
authors.forename: M Michele
authors.initials: MM
authors.lastname: Moss
authors.forename: Umesh
authors.initials: U
authors.lastname: Dyamenahalli
authors.forename: Wesley
authors.initials: W
authors.lastname: McKamie
authors.forename: William R
authors.initials: WR
authors.lastname: Morrow
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
authors.forename: Adnan T
authors.initials: AT
authors.lastname: Bhutta
mesh_terms: D002648:Child; D002675:Child, Preschool; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D011474:Prosthesis Design; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control
keywords: 27; ACA; BSID-III; Bayley Scales of Infant Development—Third Edition; CPR; CT; CTA; CVE; LVAD; MCA; MCS; PCA; RICA; VAD; WISC-IV; Wechsler Intelligence Scale for Children—Fourth Edition; aPTT; activated partial thromboplastin time; anterior cerebral artery; cardiopulmonary resuscitation; cerebrovascular event; computed tomography; computed tomography angiography; eCPR; extracorporeal cardiopulmonary resuscitation; left ventricular assist device; mechanical circulatory support; middle cerebral artery; posterior cerebral artery; right internal carotid artery; ventricular assist device