Berlin Heart EXCOR Pediatric Ventricular Assist Device for Bridge to Heart Transplantation in US Children

被引：348

作者：

Almond, Christopher S. ^{[1
]}

Morales, David L. ^{[2
,27
]}

Blackstone, Eugene H. ^{[3
,4
]}

Turrentine, Mark W. ^{[5
]}

Imamura, Michiaki ^{[6
]}

Massicotte, M. Patricia ^{[7
]}

Jordan, Lori C. ^{[8
]}

Devaney, Eric J. ^{[9
]}

Ravishankar, Chitra ^{[10
]}

Kanter, Kirk R. ^{[11
]}

Holman, William ^{[12
]}

Kroslowitz, Robert ^{[13
]}

Tjossem, Christine ^{[13
]}

Thuita, Lucy ^{[3
,4
]}

Cohen, Gordon A. ^{[14
]}

Buchholz, Holger ^{[7
]}

St Louis, James D. ^{[15
]}

Khanh Nguyen ^{[16
]}

Niebler, Robert A. ^{[17
]}

Walters, Henry L., III ^{[18
]}

Reemtsen, Brian ^{[19
]}

Wearden, Peter D. ^{[20
]}

Reinhartz, Olaf ^{[21
]}

Guleserian, Kristine J. ^{[22
]}

Mitchell, Max B. ^{[23
]}

Bleiweis, Mark S. ^{[24
]}

Canter, Charles E. ^{[25
]}

Humpl, Tilman ^{[26
]}

机构：

[1] Boston Childrens Hosp, Boston, MA USA

[2] Cincinnati Childrens Hosp, Cincinnati, OH USA

[3] Cleveland Clin, Inst Heart & Vasc, Cleveland, OH 44106 USA

[4] Cleveland Clin, Dept Quantitat Hlth Sci, Cleveland, OH 44106 USA

[5] James Whitcomb Riley Hosp Children, Indianapolis, IN 46202 USA

[6] Arkansas Childrens Hosp, Little Rock, AR 72202 USA

[7] Stollery Childrens Hosp, Edmonton, AB, Canada

[8] Vanderbilt Univ, Med Ctr, Nashville, TN USA

[9] Univ Michigan, CS Mott Childrens Hosp, Ann Arbor, MI 48109 USA

[10] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[11] Childrens Healthcare Atlanta, Atlanta, GA USA

[12] Univ Alabama Birmingham, Birmingham, AL USA

[13] Berlin Heart Inc, The Woodlands, TX USA

[14] Childrens Hosp & Reg Med Ctr Seattle, Seattle, WA USA

[15] Univ Minnesota, Minneapolis, MN USA

[16] Mt Sinai, New York, NY USA

[17] Med Coll Wisconsin, Milwaukee, WI 53226 USA

[18] Childrens Hosp Michigan, Detroit, MI 48201 USA

[19] Univ Calif Los Angeles, Mattel Childrens Hosp, Los Angeles, CA USA

[20] Childrens Hosp Pittsburgh, Pittsburgh, PA 15213 USA

[21] Stanford Univ, Palo Alto, CA 94304 USA

[22] Childrens Med Ctr, Dallas, TX 75235 USA

[23] Childrens Hosp Colorado, Aurora, CO USA

[24] Univ Florida, Gainesville, FL USA

[25] St Louis Childrens Hosp, St Louis, MO 63178 USA

[26] Hosp Sick Children, Toronto, ON M5G 1X8, Canada

[27] Texas Childrens Hosp, Houston, TX 77030 USA

来源：

CIRCULATION | 2013年 / 127卷 / 16期

关键词：

cardiac surgical procedures; heart-assist devices; heart failure; pediatrics; transplantation; waiting lists; EXTRACORPOREAL MEMBRANE-OXYGENATION; MECHANICAL CIRCULATORY SUPPORT; NORTH-AMERICAN EXPERIENCE; UNITED-STATES ANALYSIS; NATIONAL HEART; PREDICTORS; MORTALITY; SURVIVAL; INTERVAL; OUTCOMES;

D O I：

10.1161/CIRCULATIONAHA.112.000685

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background-Recent data suggest that the Berlin Heart EXCOR Pediatric ventricular assist device is superior to extracorporeal membrane oxygenation for bridge to heart transplantation. Published data are limited to 1 in 4 children who received the device as part of the US clinical trial. We analyzed outcomes for all US children who received the EXCOR to characterize device outcomes in an unselected cohort and to identify risk factors for mortality to facilitate patient selection. Methods and Results-This multicenter, prospective cohort study involved all children implanted with the Berlin Heart EXCOR Pediatric ventricular assist device at 47 centers from May 2007 through December 2010. Multiphase nonproportional hazards modeling was used to identify risk factors for early (<2 months) and late mortality. Of 204 children supported with the EXCOR, the median duration of support was 40 days (range, 1-435 days). Survival at 12 months was 75%, including 64% who reached transplantation, 6% who recovered, and 5% who were alive on the device. Multivariable analysis identified lower weight, biventricular assist device support, and elevated bilirubin as risk factors for early mortality and bilirubin extremes and renal dysfunction as risk factors for late mortality. Neurological dysfunction occurred in 29% and was the leading cause of death. Conclusions-Use of the Berlin Heart EXCOR has risen dramatically over the past decade. The EXCOR has emerged as a new treatment standard in the United States for pediatric bridge to transplantation. Three-quarters of children survived to transplantation or recovery; an important fraction experienced neurological dysfunction. Smaller patient size, renal dysfunction, hepatic dysfunction, and biventricular assist device use were associated with mortality, whereas extracorporeal membrane oxygenation before implantation and congenital heart disease were not. (Circulation. 2013; 127: 1702-1711.)

引用

页码：1702 / +

页数：21

共 43 条

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