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Joanna Y Huang, Paul Monagle, M Patricia Massicotte, Christina J VanderPluym
INTRODUCTION: Ventricular Assist Devices (VADs) are increasingly utilised in children with end-stage heart failure, and experience high bleeding and clotting rates. In particular, pediatric VAD patients are more challenging than adults to anticoagulate due to developmental hemostasis, lack of suitable drug preparations, and difficult anticoagulation monitoring often due to poor vascular access; in addition to difficulties of VAD design in smaller children. This review aims to summarize the current evidence related to antithrombotic therapy in pediatric VAD patients...
February 28, 2018: Thrombosis Research
Roland Hetzer, Mariano Francisco Del Maria Javier, Eva Maria Delmo Walter
Background: While heart transplantation has gained recognition as the gold standard therapy for advanced heart failure, the scarcity of donor organs has become an important concern. The evolution of surgical alternatives such as ventricular assist devices (VADs), allow for recovery of the myocardium and ensure patient survival until heart transplantation becomes possible. This report elaborates the role of VADs as a bridge to heart transplantation in infants and children (≤18 years old) with end-stage heart failure...
January 2018: Annals of Cardiothoracic Surgery
Katsuhide Maeda, David N Rosenthal, Olaf Reinhartz
Heart transplant waitlist survival in pediatric patients has been substantially improved since the introduction of pediatric-specific ventricular assist device. In neonates and infants, however, the waitlist mortality remains very high. The only long-term device currently approved for use in the United States is the Berlin Heart EXCOR, but this device has several important limitations because of the paracorporeal, pulsatile nature of the underlying technology. We reviewed Stanford ventricular assist experience on patients less than 1 year old since 2004...
March 2018: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
Gary S Beasley, Kristen Nelson-McMillan, Luca Vricella, William R Thompson, William Ravekes
Mechanical circulatory support options remain limited for pediatric patients, especially neonates. The only FDA-approved pediatric device remains the Berlin Heart EXCOR, which unfortunately carries with it a 20-30% risk of neurologic complications, such as strokes. We demonstrate a new technique of direct echocardiographic color-Doppler imaging of the Berlin Heart valves to detect valve regurgitation. Increases in valve regurgitation could indicate issues with pump-valve thrombosis or increased afterload leading to valve insufficiency...
January 30, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Arianna Di Molfetta, Roberta Iacobelli, Sergio Filippelli, Giorgia Grutter, Gianluigi Perri, Francesca Iodice, Luciano Pasquini, Paolo Guccione, Antonio Amodeo
The aim of this study was to describe the echocardiographic trend of left ventricular (LV) and right ventricular (RV) function after implantation of a pulsatile flow left ventricular assist device (LVAD) in children. From 2013 to 2016, we prospectively evaluated 13 consecutive pediatric Berlin Heart EXCOR LVAD patients. Clinical and echocardiographic data were collected at baseline, within 24 h after implantation and monthly until LVAD explant. Median age and weight at the implantation was 8 (4-23) months and 5 (4...
December 12, 2017: Artificial Organs
Aditya Badheka, Veerajalandhar Allareddy
Berlin Heart Inc. EXCOR is an extracorporeal pneumatically pulsatile ventricular assist device approved for use in pediatric age group since 2011 in the United States. It is a well-established life-saving therapy for the bridge to heart transplant or to provide circulatory support in a transplanted patient. The most commonly reported problem was "membrane defect" in a postmarketing major device reporting. In general, the filling and emptying of the pump can be easily visualized, but the interobserver variability exist...
March 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Seth A Hollander, Ethan J Hollander
On the day of his birth in 1971, David Vetter was "temporarily" placed in a sterile isolator to wait for a bone marrow donor who would cure his Severe Combined Immunodeficiency Syndrome. After enduring 12 years in isolation, David, now known to the world as "The Boy in the Bubble", received a bone marrow transplant from his unmatched sister and died 4 months later. Like Severe Combined Immunodeficiency Syndrome, pediatric heart failure is a rare and life-threatening condition for which organ transplantation is often the only option for survival...
November 14, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Szymon Pawlak, Roman Przybylski, Janusz Skalski, Joanna Śliwka, Andrzej Kansy, Adam Grzybowski, Arkadiusz Wierzyk, Jacek Białkowski, Bohdan Maruszewski, Marian Zembala
BACKGROUND: The treatment of advanced heart failure (HF) in children and infants poses a serious management problem. Heart failure in that patient group is usually of congenital aetiology. The treatment schedules for paediatric patients are in most cases adapted from the guidelines for treatment of adults. Up to 2009, the treatment of that extremely difficult group of patients was limited to pharmacological therapy and occasional heart transplantations. Constantly increasing problems with recruiting donors, especially for the paediatric group, contribute to the fact that mechanical support with the use of ventricular assist devices is for many children the only chance of surviving the period of waiting for a heart donor...
2018: Kardiologia Polska
Iki Adachi, Vadim Kostousov, Lisa Hensch, Martin A Chacon-Portillo, Jun Teruya
Ventricular-assist devices (VADs) have seen increased utilization in the pediatric population. Formerly, this therapeutic modality was limited to only the pulsatile VAD, EXCOR (Berlin Heart GmbH). However, the continuous flow VAD devices, HeartMate II (Abbott Inc.) and HeartWare (Medtronic Inc.), are now increasingly used in this population. Postoperatively, VAD patients are acutely anticoagulated using unfractionated heparin, often beginning 24 to 48 hours after VAD placement. Once the patient is stabilized and ready to transition to a lower acuity or outpatient setting, low-molecular-weight heparin or warfarin therapy may be instituted...
February 2018: Seminars in Thrombosis and Hemostasis
Stephanie Perrier, Alice Parker, Christian P Brizard, Bennett Sheridan, Igor E Konstantinov, Yves d'Udekem, Johann Brink
Extensive perinatal myocardial infarction caused by coronary artery thrombosis is extremely rare and has a dismal prognosis. We report a 3.5-kg neonate who presented at birth with an extensive myocardial infarction caused by aortic root and left main coronary artery thrombus after an emergency cesarean section. We performed emergency surgical thrombectomy and insertion of extracorporeal membrane oxygenation support. After subsequent conversion to long-term left ventricular assist device with an EXCOR device (Berlin Heart, Berlin, Germany), the patient had no ventricular recovery after 163 days of support...
December 2017: Annals of Thoracic Surgery
Ajay K Bhatia, Mouhammad Yabrodi, Mallory Carroll, Silvia Bunting, Kirk Kanter, Kevin O Maher, Shriprasad R Deshpande
AIM: To assess utility and correlation of known anticoagulation parameters in the management of pediatric ventricular assist device (VAD). METHODS: Retrospective study of pediatric patients supported with a Berlin EXCOR VAD at a single pediatric tertiary care center during a single year. RESULTS: We demonstrated associations between activated thromboplastin time (aPTT) and R-thromboelastography (R-TEG) values (rs = 0.65, P < 0.001) and between anti-Xa assay and R-TEG values (rs = 0...
September 26, 2017: World Journal of Cardiology
Joseph Philip, Dalia Lopez-Colon, Ravi S Samraj, Giri Kaliki, Maria V Irwin, Biagio A Pietra, Frederick J Fricker, Mark S Bleiweis
BACKGROUND: This study examines our institutional ventricular assist devices (VADs) experience over two decades to understand trends towards predictors of mortality. METHODS: Retrospective study of patients aged 0-21years supported with a VAD from January 1996 to May 2015. Patient data was examined pre and post-VAD implant among survivors and non-survivors. RESULTS: Thirty-six patients identified (8 supported by Thoratec® VAD and 28 supported by EXCOR Berlin Heart®)...
October 16, 2017: Journal of Critical Care
Charlotte S Van Dorn, Devon O Aganga, Jonathan N Johnson
PURPOSE OF REVIEW: Mechanical circulatory support (MCS) has become an indispensable tool in the management of children with impending respiratory and cardiac failure. Though extracorporeal membrane oxygenation (ECMO) was classically the only form of support available to pediatric patients, considerable advances have allowed ventricular assist devices (VADs) to become increasingly utilized in children. This review provides an update of recent advances in ECMO and VAD management in children...
January 2018: Current Opinion in Cardiology
Carlo Pace Napoleone, Maria Teresa Cascarano, Luca Deorsola, Andrea Valori
The management of failing Fontan patients with mechanical circulatory support has been reported with unsatisfactory results. A 5-year-old girl, listed for heart transplantation for failing Fontan, underwent rescue extracorporeal membrane oxygenation support. As it was necessary to move the patient to the Berlin Heart Excor, a step-by-step approach was designed to obtain a gradual adaptation to this form of support. A central extracorporeal membrane oxygenation, with a Berlin Heart apical and aortic cannulae, was implanted leaving the previously positioned femoral vein cannula in parallel with the outflow apical one...
February 1, 2018: Interactive Cardiovascular and Thoracic Surgery
Nicolas Beranger, Charlotte Veyrat-Durebex, Philippe Pouard, Bernard Lacour, Stéphanie Vicca
A five-year-old boy is presented to Necker hospital for a dilated hypertrophic cardiomyopathy. The implantation of the Berlin Heart Excor® ventricular assist device was performed. This pediatric-sized Berlin Heart® device provides mechanical support for young infants and children of all ages to sustain the failing cardiac circulation over several months, until either recovery of myocardial function or heart transplantation. It remains difficult to identify patients with sufficient recovery and the right time for explantation of the Berlin Heart®...
October 1, 2017: Annales de Biologie Clinique
Jennifer A Su, Jondavid Menteer
The outcomes of pediatric ventricular assist device support in patients with diastolic heart failure have not been well described. This study reviews the North American experience with Berlin Heart EXCOR(®) ventricular assist device implants in children with such physiology. The Berlin Heart clinical database was reviewed. Patients with primary diastolic dysfunction are included in this study. Twenty pediatric patients with restrictive cardiomyopathy (n = 13), hypertrophic cardiomyopathy (n = 3), or congenital heart disease with restrictive physiology (n = 4) who were supported with EXCOR(®) were identified...
September 14, 2017: Pediatric Transplantation
John C Dykes, Olaf Reinhartz, Christopher S Almond, Vamsi Yarlagadda, Jenna Murray, David N Rosenthal, Katsuhide Maeda
We report an infant with hypertrophic cardiomyopathy who underwent biventricular assist device placement with two 15-mL Berlin Heart EXCOR pediatric ventricular assist devices using an alternative atrial cannulation strategy. The systemic circulation was supported by left atrium (LA) to aorta cannulation. The LA was accessed through the right atrium by extending a 6-mm EXCOR cannula with a Gore-Tex graft connected to an atrial septal defect. The pulmonary circulation was supported with cannulation of the right atrium to pulmonary artery...
August 2017: Annals of Thoracic Surgery
Daniel J Beissel, Brian F Birnbaum, Aliessa P Barnes, James E O'Brien, Elizabeth M Turk, James D St Louis
Acute myocarditis may lead to left ventricular dysfunction and subsequent need for cardiac transplantation. We describe a 15-month-old child who presented with right heart failure of unclear cause. Echocardiography showed normal left ventricular function; however, right ventricular function was markedly reduced. The patient required extracorporeal membrane oxygenation followed by placement of a right-sided Berlin EXCOR ventricular assist device. There was little recovery, and the child underwent cardiac transplantation...
August 2017: Annals of Thoracic Surgery
David N Rosenthal, Chacy A Lancaster, Doff B McElhinney, Sharon Chen, MaryLyn Stein, Aileen Lin, Lan Doan, Jenna M Murray, Mary Alice Gowan, Katsuhide Maeda, Olaf Reinhartz, Christopher S Almond
BACKGROUND: Stroke is the most feared complication associated with the Berlin Heart EXCOR pediatric ventricular assist device (VAD), the most commonly used VAD in children, and affects 1 in 3 children. We sought to determine whether a modified anti-thrombotic guideline, involving more intense platelet inhibition and less reliance on platelet function testing, is associated with a lower incidence of stroke. METHODS: All children supported with the EXCOR at Stanford from 2009 to 2014 were divided into 2 cohorts based on the primary anti-thrombotic guideline used to prevent pump thrombosis: (1) the Edmonton Anti-thrombotic Guideline (EG) cohort, which included children implanted before September 2012 when dual anti-platelet therapy was used with doses titrated to Thromboelastrography/PlateletMapping (TEG/PM); and (2) the Stanford Modified Anti-thrombotic Guideline (SG) cohort, which included children implanted on or after September 2012 when triple anti-platelet therapy was used routinely and where doses were uptitrated to high, weight-based dosing targets, with low-dose steroids administered as needed for inflammation...
November 2017: Journal of Heart and Lung Transplantation
Ryan R Davies
No abstract text is available yet for this article.
November 2017: Journal of Heart and Lung Transplantation
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