title: Biventricular Berlin Heart EXCOR pediatric use across the united states.
abstract: BACKGROUND
  Biventricular assist device (BiVAD) support was a strong predictor of early mortality in the Berlin Heart EXCOR Pediatric investigational device exemption (IDE) study (Assess Safety and Probable Benefit of the EXCOR Pediatric Ventricular Assist Device [VAD]). In adults, it has been identified that 5% to 10% of the VAD population is benefited by BiVAD support over left ventricular assist device (LVAD) support. An analysis of the Berlin Heart study cohort was performed to characterize patients supported with BiVAD, examine risk factors of mortality in this group, and identify subsets of patients in whom BiVAD is associated with survival.
  
  
  METHODS
  All EXCOR Pediatric devices (Berlin Heart, Inc, The Woodlands, TX) placed in North America between May 2007 and December 2010 comprised the study cohort of 204 patients (128 [63%] LVADs and 76 [37%] BiVADs). The following patient cohorts were analyzed to determine the effect of BiVAD use on survival: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 patients, patients with abnormal bilirubin levels, patients who received previous extracorporeal membrane oxygenation (ECMO), and patients with a 10-mL pump size.
  
  
  RESULTS
  There were more patients with BiVADs in INTERMACS profile 1 (63% compared with 46%; p = 0.018). The incidence of major bleeding, neurologic and renal dysfunction, and infection was similar between BiVAD and LVAD groups. White race, abnormal glomerular filtration rate (GFR), sites with experience of less than 5 implantations, and use of 10-mL pumps were predictors of mortality in patients who received BiVADs. BiVADs were not associated with improved survival in any patient cohort; however, they were associated with increased mortality in patients who had undergone ECMO before receiving a VAD.
  
  
  CONCLUSIONS
  BiVAD support was not associated with improved survival in any identified subset of patients. Although not randomized, these results (which were corrected for multiple possible risk factors) suggest that some children supported with BiVADs might have done better with LVADs alone. Further prospective studies will be needed to identify patient cohorts that will be better served with BIVAD support.
authors.affiliation: Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Farhan
authors.initials: F
authors.lastname: Zafar
authors.affiliation: Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: John L
authors.initials: JL
authors.lastname: Jefferies
authors.affiliation: Berlin Heart, Inc, The Woodlands, Texas.
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Tjossem
authors.affiliation: Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Roosevelt
authors.initials: R
authors.lastname: Bryant
authors.affiliation: Duke Children's Hospital, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Robert D B
authors.initials: RD
authors.lastname: Jaquiss
authors.affiliation: Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Wearden
authors.affiliation: Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
authors.forename: David N
authors.initials: DN
authors.lastname: Rosenthal
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Cabrera
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Rossano
authors.affiliation: Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tilman
authors.initials: T
authors.lastname: Humpl
authors.affiliation: Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: david.morales@cchmc.org.
authors.forename: David L S
authors.initials: DL
authors.lastname: Morales
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004867:Equipment Design; D004869:Equipment Safety; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality; D006352:Heart Ventricles / Q000503:physiopathology*; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000145:classification* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010372:Pediatrics / Q000379:methods; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States