title: Mechanical circulatory support in the Dutch National Paediatric Heart Transplantation Programme.
abstract: OBJECTIVE
  Mechanical circulatory support (MCS) with a ventricular assist device (VAD) as a bridge to heart transplantation (HTx) or recovery may improve outcome in children with terminal heart failure. We report our experience with MCS in children eligible for HTx and its effect on waiting list mortality.
  
  
  METHODS
  Retrospective single-centre cohort study, National Paediatric HTx Programme including all children eligible for HTx, since the introduction of MCS-VAD in 2006.
  
  
  RESULTS
  A total of 43 patients were eligible for HTx, median age 11.7 years [Inter Quartile Range (IQR) 3.0-14.7]. In 18 patients, (42%) a VAD was implanted, 11 (61%) survived to HTx (n = 9) or recovery (n = 2). Techniques and devices used were left ventricular assist device (n = 16, 89%), in 4 cases preceded by extracorporeal membrane oxygenation (ECMO), and biventricular assist device (n = 2, 11%), both preceded by ECMO. In the VAD group, median time to death (n = 7) was 18 days (IQR 7-75), median time to HTx (n = 9) 66 days (IQR 33-223) and 2 patients recovered after 30 and 308 days. The main cause of death on MCS was neurological injury in 4 patients (22%) and systemic thrombo-embolic events in 2 (11%). The most common serious adverse events included confirmed thrombus requiring pump replacement (in 11 patients, 61%) and pericardial effusion leading to rethoracotomy (in 5 patients, 28%). Compared with the era before MCS (1998-2006), waiting list mortality decreased from 44 to 21%, and is now mainly related to complications of VAD support.
  
  
  CONCLUSIONS
  Since the introduction of MCS-VAD, waiting list mortality halved and more children with end-stage heart failure survived to heart transplantation, thus improving outcome. Although there is substantial mortality and morbidity, overall mortality decreases, making MCS-VAD an essential therapeutic tool. The need for donor organs remains critically urgent.
authors.affiliation: Department of Pediatric Cardiology, Erasmus Medical Center, Rotterdam, Netherlands Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Marijke H
authors.initials: MH
authors.lastname: van der Meulen
authors.affiliation: Department of Pediatric Cardiology, Erasmus Medical Center, Rotterdam, Netherlands m.dalinghaus@erasmusmc.nl.
authors.forename: Michiel
authors.initials: M
authors.lastname: Dalinghaus
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Alexander P W M
authors.initials: AP
authors.lastname: Maat
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: van de Woestijne
authors.affiliation: Department of Pediatric Cardiology, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Osch
authors.affiliation: Department of Pediatric Intensive Care, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: de Hoog
authors.affiliation: Department of Pediatric Intensive Care, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Ulrike S
authors.initials: US
authors.lastname: Kraemer
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D016027:Heart Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014850:Waiting Lists / Q000401:mortality
keywords: Extracorporeal circulation; Mechanical circulatory assistance; Transplantation–heart