title: Mechanical cardiac support in children with congenital heart disease with intention to bridge to heart transplantation†.
abstract: OBJECTIVE
  A significant number of children affected by congenital heart disease (CHD) develop heart failure early or late after surgery, and heart transplantation (OHTx) remains the last treatment option. Due to shortage of donor organs in paediatric group, mechanical circulatory support (MCS) is now routinely applied as bridging strategy to increase survival on the waiting list for OTHx. We sought to assess the impact of MCS as intention to bridge to OHTx in patients with CHD less than 16 years of age.
  
  
  METHODS
  From 1998 to 2013, 106 patients received 113 episodes of MCS with paracorporeal devices as intention to bridge to OHTx. Twenty-nine had CHD, 15 (52%) with two-ventricle (Group A) and 14 (48%) with single-ventricle physiology (Group B). In Group A, 5 children had venoarterial extracorporeal membrane oxygenation (VA ECMO), 6 left ventricular assist device (LVAD), 2 biventricular assist device (BIVAD), 1 VA ECMO followed by BIVAD and 1 BIVAD followed by VA ECMO. In Group B, VA ECMO was used in 7 children, univentricular assist device (UVAD) changed to VA ECMO in 4, UVAD in 2 and surgical conversion to two-ventricles physiology with BIVAD support changed to VA ECMO in 1.
  
  
  RESULTS
  Twenty-one of 29 (72%) children survived to recovery/OHTx. Seven of 29 (59%) survived to discharge. In Group A, 11/15 (73%) survived to recovery/OHTx and 9/15 (60%) survived to discharge. Four of 15 (27%) died awaiting OHTx. One child had graft failure requiring VA ECMO and was bridged successfully to retransplantation. One child dying after OHTx had acute rejection, was supported with VA ECMO and then BIVAD but did not recover. One patient had an unsuccessful second run on BIVAD 1 year after recovery from VA ECMO. In Group B, 10/14 (71%) survived to recovery/OHTx and 8/14 (57%) survived to discharge. Four of 14 (29%) died awaiting OHTx. Of deaths after OHTx, 1 occurred intraoperatively and 1 was consequent to graft failure and had an unsuccessful second run with VA ECMO.
  
  
  CONCLUSIONS
  Children with CHD can be successfully bridged with MCS to heart transplantation. Single-ventricle circulation compared with biventricular physiology does not increase the risk of death before transplant or before hospital discharge.
authors.affiliation: Department of Paediatric Cardiac Surgery, Freeman Hospital, Newcastle Upon Tyne, UK fabrizio.derita@nuth.nhs.uk.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: De Rita
authors.affiliation: Department of Paediatric Cardiac Surgery, Freeman Hospital, Newcastle Upon Tyne, UK.
authors.forename: Asif
authors.initials: A
authors.lastname: Hasan
authors.affiliation: Paediatric Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Haynes
authors.affiliation: Paediatric Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK.
authors.forename: David
authors.initials: D
authors.lastname: Crossland
authors.affiliation: Paediatric Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Kirk
authors.affiliation: Paediatric Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.
authors.forename: Lee
authors.initials: L
authors.lastname: Ferguson
authors.affiliation: Department of Paediatric Cardiac Surgery, Freeman Hospital, Newcastle Upon Tyne, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Peng
authors.affiliation: Department of Paediatric Cardiac Surgery, Freeman Hospital, Newcastle Upon Tyne, UK.
authors.forename: Massimo
authors.initials: M
authors.lastname: Griselli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies
keywords: Congenital heart disease; Extracorporeal membrane oxygenator; Heart transplantation; Mechanical circulatory support