Comparison of paracorporeal and continuous flow ventricular assist devices in children: preliminary results.
With the scarcity of organs, a durable, reliable ventricular assist device (VAD) is required. The Berlin Heart EXCOR ® (BH) remains the most established VAD in the paediatric population. Implantable continuous flow (CF) VADs have been introduced to the paediatric field with encouraging early results. In this study, we compared the results of a newly introduced CF VAD (HeartWare VAD [HVAD] ® ) to results in a matched group of BH recipients.



The study included patients aged <16 years who received mechanical left VAD (LVAD) support between December 2005 and January 2016. The preimplant characteristics and postimplant outcomes of patients who received the HVAD were compared with those of a matched group who received the BH. Patients with congenital heart disease were excluded.



Thirty patients were included in the study: 13 had received the HVAD and were matched with 17 patients who had received the BH LVAD. The only difference in preimplant characteristics was the need for higher inotropic support in the BH group. There was no difference in the need for right ventricular (RV) support (58.8% for BH vs 53.8% for HVAD, P  = 1.00) or in the incidence of cerebrovascular accidents (12.5% vs 7.7%, respectively, P  = 1.00), though the BH group showed prolonged mechanical ventilation (31.3% vs 0%, P  = 0.047). There were no deaths while on VAD support in either group. Patients with the HVAD showed a bimodal distribution for the primary end point (transplant/explant): All HVAD recipients who also required early RV support reached this end point within 30 days of receiving the implant.



Our early experience with the CF intracorporeal LVAD system (HVAD) indicates outcomes comparable to those with the well-established pulsatile flow paracorporeal LVAD (BH). The theoretical durability of the CF device, which might also allow for the possibility of hospital discharge and better quality of life, is yet to be proven.
Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.|Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.|Department of Cardiothoracic Surgery, Alexandria University, Alexandria, Egypt.
Mohamed S
MS
Nassar
Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.|Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.
Asif
A
Hasan
Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.
Teresa
T
Chila
Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.
Stephan
S
Schueler
Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.
Carola
C
Pergolizzi
Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.|Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.
Zdenka
Z
Reinhardt
Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.
Stephen
S
Lord
Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.|Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.
Fabrizio
F
De Rita
Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.
Lee
L
Ferguson
Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.
Jon
J
Smith
Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.
Simon
S
Haynes
Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.
John
J
O'Sullivan
Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.|Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.
Bari
B
Murtuza
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011673:Pulsatile Flow; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
Berlin Heart; Continuous; Durability; Heart failure; HeartWare; Mechanical support; Paediatric; Pulsatile; Ventricular assist device