title: Post-transplant outcomes of children bridged to transplant with the Berlin Heart EXCOR Pediatric ventricular assist device.
abstract: BACKGROUND
  Recent data suggest that Berlin Heart EXCOR Pediatric (EXCOR) ventricular assist device improves waiting list survival for pediatric heart transplant candidates. Little is known about their post-transplant outcomes. The aim of this analysis was to determine whether there was a difference in early survival for children bridged to transplant with EXCOR versus status 1A pediatric heart transplant patients not transplanted with ventricular assist device support.
  
  
  RESULTS
  Pediatric heart transplant patients (n=106) bridged to transplantation with EXCOR were compared with a similarly aged cohort (n=1021) within the Organ Procurement and Transplant Network (OPTN) database (both cohorts from May 2007 to December 2010). In the EXCOR group, 12-month post-transplant survival (88.7%) was similar to OPTN patients listed status 1A who were not on ventricular assist device support at transplant (89.3%; P=0.85) and significantly better than 12-month survival in OPTN patients on extracorporeal membrane oxygenation at transplant (60.3%; P<0.001). Rejection (50%) was a significantly (P=0.005) higher cause of 12-month post-transplant mortality in the EXCOR compared with the OPTN group. Death after transplant was also higher in EXCOR patients with congenital heart disease compared with those with cardiomyopathy (26.1% versus 7.2%; P=0.02). Post-transplant survival was similar in EXCOR patients with ≥1 serious adverse event during ventricular assist device support as those without an event during support.
  
  
  CONCLUSIONS
  The 12-month post-transplant survival with EXCOR is comparable with overall pediatric heart transplant survival and superior to survival after extracorporeal membrane oxygenation. Neither adverse events during support nor factors associated with mortality during support influence post-transplant survival. Rejection was a significantly greater cause of post-transplant mortality in EXCOR than in OPTN patients.
authors.affiliation: St. Louis Children's Hospital, St. Louis, MO (P.E., D.E., C.C.); Boston Children's Hospital, Boston, MA (C.S.D.A.); Berlin Heart, Inc, The Woodlands, TX (C.T.); Arkansas Children's Hospital, Little Rock, AR (M.I.); Riley Hospital for Children, Indianapolis, IN (M.T.); Children's Hospital of Wisconsin, Milwaukee, WI (J.T.); and Duke Children's Hospital, Durham, NC (R.D.B.J.).
authors.forename: Pirooz
authors.initials: P
authors.lastname: Eghtesady
authors.forename: Christopher S D
authors.initials: CS
authors.lastname: Almond
authors.forename: Christine
authors.initials: C
authors.lastname: Tjossem
authors.forename: Deirdre
authors.initials: D
authors.lastname: Epstein
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
authors.forename: Mark
authors.initials: M
authors.lastname: Turrentine
authors.forename: James
authors.initials: J
authors.lastname: Tweddell
authors.forename: Robert D B
authors.initials: RD
authors.lastname: Jaquiss
authors.forename: Charles
authors.initials: C
authors.lastname: Canter
mesh_terms: D000293:Adolescent; D001604:Berlin; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality / Q000517:prevention & control; D016027:Heart Transplantation / Q000401:mortality / Q000639:trends*; D006353:Heart-Assist Devices / Q000639:trends*; D006801:Humans; D008297:Male; D011182:Postoperative Care / Q000401:mortality / Q000639:trends*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: heart failure; heart-assist device; pediatrics; surgery; transplantation