Management of pediatric patients after implantation of the Berlin Heart EXCOR ventricular assist device

Within the last 16 years, the Berlin Heart EXCOR systems have been used for circulatory support in 73 infants and children up to 17 years of age (mean, 7 years) with severe circulatory failure resistant to pharmacological therapy at our institution. These were patients with cardiomyopathy, fulminant myocarditis, end-stage congenital cardiac defects, and acute heart failure after congenital heart surgery. Mean EXCOR support time was 36 days (range, 1 to 420 days). Forty-four patients (62%) survived up to transplantation or after weaning and 37 (51%) of them, including 9 infants, were discharged home. These results in patients with very advanced disease have improved significantly during the past few years as the result of technical developments and growing experience in the treatment of patients on the device and in postoperative care. The following article gives answers to five questions frequently asked about intensive care unit treatment while on the device, anticoagulation and additional medical support during left ventricular or biventricular support, the daily treatment of the children, and options for the weaning procedure.