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Chalia M, Singh D, Boyd SG, Hannam S, Hoskote A, Pressler R. Neonatal seizures during extra corporeal membrane oxygenation support. Eur J Pediatr 2024:10.1007/s00431-024-05510-w. [PMID: 38488877 DOI: 10.1007/s00431-024-05510-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 03/17/2024]
Abstract
To evaluate EEG monitoring during neonatal ECMO and to identify any correlations between seizure detection to abnormal neuroimaging. Eight-year, service evaluation of neonates who received at least one continuous EEG (cEEG) whilst on ECMO at Great Ormond Street Hospital. Pearson's chi-square test and multivariate logistic regression analysis were used to assess clinical and EEG variables association with seizures and neuroimaging findings. Fifty-seven neonates were studied; 57 cEEG recordings were reviewed. The incidence of seizures was 33% (19/57); of these 74% (14/19) were electrographic-only. The incidence of status epilepticus was 42%, (8/19 with 6 neonates having electrographic-only status and 2 electro-clinical status. Seizures were detected within an hour of recording in 84%, (16/19). The overall mortality rate was 39% (22/57). Seizure detection was strongly associated with female gender (OR 4.8, 95% CI: 1.1-20.4, p = 0.03), abnormal EEG background activity (OR 2.8, 95% CI: 1.1-7.4, p = 0.03) and abnormal EEG focal features (OR 23.6, 95% CI: 5.4-103.9, p = 0.001). There was a strong association between the presence of seizures and abnormal neuroimaging findings (OR 10.9, 95% CI: 2.8-41.9, p = 0.001). Neonates were highly likely to have abnormal neuroimaging findings in the presence of severely abnormal background EEG (OR 9.5, 95% CI 1.7-52.02, p = 0.01) and focal EEG abnormalities (OR 6.35, 95% CI 1.97-20.5, p = 0.002)Conclusion: The study highlights the importance of cEEG in neonates undergoing ECMO. An association between seizure detection and abnormal neuroimaging findings was described. What is Known: • Patients on ECMO are at a higher risk of seiures. • Continuous EEG monitoring is recommended by the ACNS for high risk and ECMO patients. What is New: • In this cohort, neonates with sezirues were 11 times more likely of having abnromal neuroimaging findings. • Neonates with burst suppressed or suppressed EEG background were 9.5 times more likely to have abnormal neuroimaging findings. What does this study add? • This study reports a 33% incidence of neonatal seizures during ECMO. • Neonates with seizures were 11 times more likely to have an abnormal brain scan. • The study captures the real-time approach of EEG monitoring. • Recommended cEEG monitoring should last at least 24 h for ECMO patients. • This is the first study to assess this in neonates only.
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Affiliation(s)
- Maria Chalia
- Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
- Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - Davinder Singh
- Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
| | - Stewart G Boyd
- Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Simon Hannam
- Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Aparna Hoskote
- Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
| | - Ronit Pressler
- Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
- Clinical Neuroscience, University College London, UCL, Great Ormond Street Institute of Child Health, London, UK
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Rohde S, Sandica E, Veen K, Kraemer US, Thiruchelvam T, Miera O, Lopez MLP, Sliwka J, Amodeo A, Bogers AJJC, de By TMMH. Outcomes in small children on Berlin Heart EXCOR support: age and body surface area as clinical predictive factors. Eur J Cardiothorac Surg 2022; 63:6809124. [PMID: 36346169 PMCID: PMC9825200 DOI: 10.1093/ejcts/ezac516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/25/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The Berlin Heart EXCOR (BHE) offers circulatory support across all paediatric ages. Clinically, the necessary care and the outcomes differ in various age groups. The EUROMACS database was used to study age- and size-related outcomes for this specific device. METHODS All patients <19 years of age from the EUROMACS database supported with a BHE between 2000 and November 2021 were included. Maximally selected rank statistics were used to determine body surface area (BSA) cut-off values. Multivariable Cox proportional hazard regression using ridge penalization was performed to identify factors associated with outcomes. RESULTS In total, 303 patients were included [mean age: 2.0 years (interquartile range: 0.6-8.0, males: 48.5%)]. Age and BSA were not significantly associated with mortality (n = 74, P = 0.684, P = 0.679). Factors associated with a transplant (n = 175) were age (hazard ratio 1.07, P = 0.006) and aetiology other than congenital heart disease (hazard ratio 1.46, P = 0.020). Recovery rates (n = 42) were highest in patients with a BSA of <0.53 m2 (21.8% vs 4.3-7.6% at 1 year, P = 0.00534). Patients with a BSA of ≥0.73 m2 had a lower risk of early pump thrombosis but a higher risk of early bleeding compared to children with a BSA of <0.73 m2. CONCLUSIONS Mortality rates in Berlin Heart-supported patients cannot be predicted by age or BSA. Recovery rates are remarkably high in the smallest patient category (BSA <0.53 m2). This underscores that the BHE is a viable therapeutic option, even for the smallest and youngest patients.
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Affiliation(s)
- Sofie Rohde
- Corresponding author. Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. E-mail: (S. Rohde)
| | - Eugen Sandica
- Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Kevin Veen
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ulrike S Kraemer
- Department of Paediatric Intensive Care, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Maria L Polo Lopez
- Department of Pediatric and Congenital Cardiac Surgery, La Paz University Hospital, Madrid, Spain
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
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Complications in children with ventricular assist devices: systematic review and meta-analyses. Heart Fail Rev 2021; 27:903-913. [PMID: 33661404 DOI: 10.1007/s10741-021-10093-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
Heart failure is a significant cause of mortality in children with cardiovascular diseases. Treatment of heart failure depends on patients' symptoms, age, and severity of their condition, with heart transplantation required when other treatments are unsuccessful. However, due to lack of fitting donor organs, many patients are left untreated, or their transplant is delayed. In these patients, ventricular assist devices (VADs) are used to bridge to heart transplant. However, VAD support presents various complications in patients. The aim of this study was to compile, review, and analyse the studies reporting risk factors and aetiologies of complications of VAD support in children. Random effect risk ratios (RR) with 95% confidence intervals were calculated to analyse relative risk of thrombosis (RR = 3.53 [1.04, 12.06] I2 = 0% P = 0.04), neurological problems (RR = 0.95 [0.29, 3.15] I2 = 53% P = 0.93), infection (RR = 0.31 [0.05, 2.03] I2 = 86% P = 0.22), bleeding (RR = 2.57 [0.76, 8.66] I2 = 0% P = 0.13), and mortality (RR = 2.20 [1.36, 3.55] I2 = 0% P = 0.001) under pulsatile-flow and continuous-flow VAD support, relative risk of mortality (RR = 0.45 [0.15, 1.37] I2 = 36% P = 0.16) under left VAD and biVAD support, relative risk of thrombosis (RR = 1.72 [0.46, 6.44] I2 = 0% P = 0.42), infection (RR = 1.77 [0.10, 32.24] I2 = 46% P = 0.70) and mortality (RR = 0.92 [0.14, 6.28] I2 = 45% P = 0.93) in children with body surface area < 1.2 m2 and > 1.2 m2 under VAD support, relative risk of mortality in children supported with VAD and diagnosed with cardiomyopathy and congenital heart diseases (RR = 1.31 [0.10, 16.61] I2 = 73% P = 0.84), and cardiomyopathy and myocarditis (RR = 0.91 [0.13, 6.24] I2 = 58% P = 0.92). Meta-analyses results show that further research is necessary to reduce complications under VAD support.
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Santamaria RL, Jeewa A, Cedars A, Buchholz H, Conway J. Mechanical Circulatory Support in Pediatric and Adult Congenital Heart Disease. Can J Cardiol 2020; 36:223-233. [DOI: 10.1016/j.cjca.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 12/30/2022] Open
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Gravino R, Limongelli G, Petraio A, Masarone D, Russo MG, Maiello C, Verrengia M, De Paulis D, Pacileo G. Berlin Heart EXCOR® pediatric ventricular assist device in a patient with Sotos syndrome: a case report. J Med Case Rep 2019; 13:286. [PMID: 31470900 PMCID: PMC6717362 DOI: 10.1186/s13256-019-2190-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 07/04/2019] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Berlin Heart EXCOR® pediatric ventricular assist device is a mechanical circulatory support device currently used in pediatric patients. Sotos syndrome is a well-described multiple anomaly syndrome characterized by overgrowth, distinctive craniofacial appearance, cardiac abnormalities, and variable learning disabilities. CASE PRESENTATION We describe a 7-year-old female Caucasian child with classic Sotos syndrome features subjected to implantation of Berlin Heart EXCOR® pediatric biventricular assist device mechanical support. A heart transplant was carried out after a support time of 459 days. After 5 years of follow-up, our patient is clinically stable and the performance of the transplanted heart is excellent. CONCLUSION This case confirms that Berlin Heart EXCOR® pediatric ventricular assist device can provide satisfactory and safe circulatory support for children with end-stage heart diseases, even in those with Sotos syndrome. The syndrome is not a contraindication to implantation, since the complications are the same as those observed in patients without the syndrome and the prognosis is not affected by the disease.
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Affiliation(s)
- Rita Gravino
- Department of Heart Failure Unit, Monaldi Hospital, via Leonardo Bianchi, 80131 Naples, Italy
| | - Giuseppe Limongelli
- Department of Pediatric Cardiology Unit, Second University of Naples, Monaldi Hospital, Naples, Italy
| | - Andrea Petraio
- Department of Cardiac Transplant Unit, Monaldi Hospital, Naples, Italy
| | - Daniele Masarone
- Department of Heart Failure Unit, Monaldi Hospital, via Leonardo Bianchi, 80131 Naples, Italy
| | - Maria Giovanna Russo
- Department of Pediatric Cardiology Unit, Second University of Naples, Monaldi Hospital, Naples, Italy
| | - Ciro Maiello
- Department of Cardiac Transplant Unit, Monaldi Hospital, Naples, Italy
| | - Marina Verrengia
- Department of Heart Failure Unit, Monaldi Hospital, via Leonardo Bianchi, 80131 Naples, Italy
| | - Danilo De Paulis
- Department of Neurosurgery, San Anna & San Sebastiano City Hospital Caserta, Caserta, Italy
| | - Giuseppe Pacileo
- Department of Heart Failure Unit, Monaldi Hospital, via Leonardo Bianchi, 80131 Naples, Italy
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6
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Miera O, Morales DLS, Thul J, Amodeo A, Menon AK, Humpl T. Improvement of survival in low-weight children on the Berlin Heart EXCOR ventricular assist device support†. Eur J Cardiothorac Surg 2018; 55:913-919. [DOI: 10.1093/ejcts/ezy394] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/15/2018] [Accepted: 10/25/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - David L S Morales
- Department of Pediatric Cardiothoracic Surgery, Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Josef Thul
- Department of Pediatric Cardiology, Pediatric Heart Center, University Hospital Giessen, Justus-Liebig University, Giessen, Germany
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children Hospital, Rome, Italy
| | | | - Tilman Humpl
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
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7
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Huang JY, Monagle P, Massicotte MP, VanderPluym CJ. Antithrombotic therapies in children on durable Ventricular Assist Devices: A literature review. Thromb Res 2018; 172:194-203. [DOI: 10.1016/j.thromres.2018.02.145] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 11/30/2022]
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Maruyama D, Kataoka H, Satow T, Mori H, Ito Y, Hamano E, Tanaka S, Ishiguro T, Chikuie H, Takahashi JC. Neurosurgical Management and Outcomes of Cerebrovascular Disease in Pediatric Patients with Heart Disease. Neurol Med Chir (Tokyo) 2018; 58:334-340. [PMID: 29998935 PMCID: PMC6092604 DOI: 10.2176/nmc.st.2018-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Antithrombotic treatment has substantial risks, even in pediatric patients. We retrospectively evaluated the management and outcomes of consecutive pediatric patients who underwent neurosurgical treatment for cerebrovascular disease with cardiovascular disease between 1998 and 2017. Patients were divided into patients with comorbid cardiovascular disease (group I); and patients with cardiovascular disease as a primary disease of intracranial complication, without (group IIa) or with (group IIb) extracorporeal circulations. Postoperative resumption of antithrombotic agents was generally initiated within 48 h. Our study included 26 patients; five were categorized as group I, 15 as group IIa, and six as group IIb. All intracranial diseases in groups IIa and IIb were exclusively hemorrhagic. Preoperative anticoagulation therapy was used in one patient (20%) in group I, 13 patients (86.7%) in group IIa, and six patients (100%) in group IIb. Postoperative intracranial hemorrhagic events were observed in one patient (20%) in group I, three patients (20%) in group IIa, and four patients (66.7%) in group IIb. Re-operations were conducted in two (13.3%) and three patients (50%) in groups IIa and IIb, respectively. Death occurred in five (33.3%) and four patients (66.7%) in groups IIa and IIb, respectively. The remaining two patients in group IIb returned to candidate status for implantation. Emergent surgery for patients with intracranial hemorrhage associated with cardiovascular disease has a high risk of postoperative hemorrhagic events and high rate of re-operations with poor vital outcomes, especially in patients with extracorporeal circulations. We should consider maximum neurosurgical treatment achievable with optimal management of antithrombotic treatment.
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Affiliation(s)
- Daisuke Maruyama
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Hisae Mori
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Yoshiro Ito
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Eika Hamano
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Shunichi Tanaka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Taichi Ishiguro
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Hidekazu Chikuie
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
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9
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Miera O, Schmitt KL, Akintuerk H, Boet A, Cesnjevar R, Chila T, Fleck T, Goldwasser R, Guereta LG, Heineking B, Hoerer J, Horke A, Hsia TY, Huebler M, Kansy A, Karimova A, Maruszewski B, Medrano C, Pawlak S, Reinhardt Z, Romlin B, Sandica E, Schmidt F, Schramm R, Schweiger M, Śliwka J, Stiller B, Thul J, Amodeo A. Antithrombotic therapy in pediatric ventricular assist devices: Multicenter survey of the European EXCOR Pediatric Investigator Group. Int J Artif Organs 2018; 41:385-392. [DOI: 10.1177/0391398818773040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objectives: Mechanical circulatory support for pediatric heart failure patients with the Berlin Heart EXCOR ventricular assist system is the only approved and established bridging strategy for recovery or heart transplantation. In recent years, the burden of thromboembolic events has led to modifications of the recommended antithrombotic therapy. Therefore, we aimed to assess modifications of antithrombotic practice among the European EXCOR Pediatric Investigator Group members. Methods: We sent a questionnaire assessing seven aspects of antithrombotic therapy to 18 European hospitals using the EXCOR device for children. Returned questionnaires were analyzed and identified antithrombotic strategies were descriptively compared to “Edmonton protocol” recommendations developed for the US EXCOR pediatric approval study. Results: Analysis of 18 received surveys revealed substantial deviations from the Edmonton protocol, including earlier start of heparin therapy at 6–12 h postoperatively and in 50% of surveyed centers, monitoring of heparin effectiveness with aPTT assay, administering vitamin K antagonists before 12 months of age. About 39% of centers use higher international normalized ratio targets, and platelet inhibition is changed in 56% including the use of clopidogrel instead of dipyridamole. Significant inter-center variability with multiple deviations from the Edmonton protocol was discovered with only one center following the Edmonton protocol completely. Conclusion: Current antithrombotic practice among European EXCOR users representing the treatment of more than 600 pediatric patients has changed over time with a trend toward a more aggressive therapy. There is a need for systematic evidence-based evaluation and harmonization of developmentally adjusted antithrombotic management practices in prospective studies toward revised recommendations.
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Affiliation(s)
- Oliver Miera
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Katharina L Schmitt
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Hakan Akintuerk
- Pediatric Heart Center, University Hospital Giessen, Justus Liebig University, Giessen, Germany
| | - Angele Boet
- Cardiac ICU, “Marie Lannelongue” Surgical Center, South Paris University Hospitals, Paris, France
| | - Robert Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Teresa Chila
- Department of Pediatric Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Freiburg, Germany
| | - Ranny Goldwasser
- Department of Pediatric Cardiology/Congenital Heart Disease, Heidelberg University Hospital, Heidelberg, Germany
| | - Luis G Guereta
- Pediatric Cardiology, University Hospital La Paz, Madrid, Spain
| | - Beatrice Heineking
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Juergen Hoerer
- Cardiac ICU, “Marie Lannelongue” Surgical Center, South Paris University Hospitals, Paris, France
| | - Alexander Horke
- Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Hannover, Germany
| | - Tain Y Hsia
- Department of Pediatric Cardiology, Great Ormond Street Hospital for Children, London, UK
| | - Michael Huebler
- Department of Congenital Pediatric Surgery, Zurich Children’s Hospital, Zurich, Switzerland
| | - Andrzej Kansy
- Department of Cardiothoracic Surgery, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Ann Karimova
- Department of Pediatric Cardiology, Great Ormond Street Hospital for Children, London, UK
| | - Bohdan Maruszewski
- Department of Cardiothoracic Surgery, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Constancio Medrano
- Pediatric Cardiology Division, Hospital Materno Infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Szymon Pawlak
- Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Zdenka Reinhardt
- Department of Pediatric Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Birgitta Romlin
- Department of Pediatric Anesthesia and Intensive Care, Queen Silvia Children’s Hospital, Gothenburg, Sweden
| | - Eugen Sandica
- Center for Congenital Heart Defects, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Florian Schmidt
- Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Hannover, Germany
| | - René Schramm
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Zurich Children’s Hospital, Zurich, Switzerland
| | - Joanna Śliwka
- Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Freiburg, Germany
| | - Josef Thul
- Pediatric Heart Center, University Hospital Giessen, Justus Liebig University, Giessen, Germany
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
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Voicu S, Sideris G, Dillinger JG, Yannopoulos D, Deye N, Kang C, Bonneau M, Bartos J, Kedra A, Bailliart S, Pasteur-Rousseau A, Amah G, Bonnin P, Callebert J, Henry P, Megarbane B. Synchronized Pulsatile Flow With Low Systolic Output From Veno-Arterial Extracorporeal Membrane Oxygenation Improves Myocardial Recovery After Experimental Cardiac Arrest in Pigs. Artif Organs 2018; 42:597-604. [DOI: 10.1111/aor.13089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/26/2017] [Accepted: 10/31/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Sebastian Voicu
- Medical and Toxicological Intensive Care; Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris; Paris France, INSERM U1144, Paris France
| | - Georgios Sideris
- Cardiology Department, Hôpital Lariboisière Assistance Publique - Hôpitaux de Paris; Paris Île-de-France, France, INSERM U942, Paris France
| | - Jean-Guillaume Dillinger
- Cardiology Department, Hôpital Lariboisière Assistance Publique - Hôpitaux de Paris; Paris Île-de-France, France, INSERM U942, Paris France
| | - Demetris Yannopoulos
- Division of Cardiology Department of Medicine; University of Minnesota Medical Center; Minneapolis MN USA
| | - Nicolas Deye
- Medical and Toxicological Intensive Care, Hôpital Lariboisière; Assistance Publique - Hôpitaux de Paris; Paris, France, INSERM U942, Paris France
| | - Chantal Kang
- Centre de Recherche en Imagerie Interventionnelle radiologie; INRA; Jouy-en-Josas France
| | - Michel Bonneau
- Centre de Recherche en Imagerie Interventionnelle radiologie; INRA; Jouy-en-Josas France
| | - Jason Bartos
- Division of Cardiology Department of Medicine; University of Minnesota Medical Center; Minneapolis MN USA
| | - Antoni Kedra
- Physiology Department, Hôpital Lariboisière; Assistance Publique - Hôpitaux de Paris; Paris France
| | | | - Adrien Pasteur-Rousseau
- Physiology Department, Hôpital Lariboisière; Assistance Publique - Hôpitaux de Paris; Paris France
| | - Guy Amah
- Physiology Department, Hôpital Lariboisière; Assistance Publique - Hôpitaux de Paris; Paris France
| | - Philippe Bonnin
- Physiology Department, Hôpital Lariboisière; Assistance Publique - Hôpitaux de Paris; Paris France
| | - Jacques Callebert
- Clinical Biochemistry Department, Hôpital Lariboisière; Assistance Publique - Hôpitaux de Paris; Paris France, INSERM U1144, Paris France
| | - Patrick Henry
- Cardiology Department, Hôpital Lariboisière Assistance Publique - Hôpitaux de Paris; Paris Île-de-France, France, INSERM U942, Paris France
| | - Bruno Megarbane
- Medical and Toxicological Intensive Care; Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris; Paris France, INSERM U1144, Paris France
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11
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Impact of a modified anti-thrombotic guideline on stroke in children supported with a pediatric ventricular assist device. J Heart Lung Transplant 2017; 36:1250-1257. [DOI: 10.1016/j.healun.2017.05.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/20/2017] [Accepted: 05/18/2017] [Indexed: 11/21/2022] Open
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12
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Di Molfetta A, Ferrari G, Iacobelli R, Filippelli S, Fresiello L, Guccione P, Toscano A, Amodeo A. Application of a Lumped Parameter Model to Study the Feasibility of Simultaneous Implantation of a Continuous Flow Ventricular Assist Device (VAD) and a Pulsatile Flow VAD in BIVAD Patients. Artif Organs 2017; 41:242-252. [PMID: 28281287 DOI: 10.1111/aor.12911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 11/18/2016] [Accepted: 12/07/2016] [Indexed: 11/30/2022]
Abstract
The aim of this work is to develop and test a lumped parameter model of the cardiovascular system to simulate the simultaneous use of pulsatile (P) and continuous flow (C) ventricular assist devices (VADs) on the same patient. Echocardiographic and hemodynamic data of five pediatric patients undergoing VAD implantation were retrospectively collected and used to simulate the patients' baseline condition with the numerical model. Once the baseline hemodynamic was reproduced for each patient, the following assistance modalities were simulated: (a) CVAD assisting the right ventricle and PVAD assisting the left ventricle (RCF + LPF), (b) CVAD assisting the left ventricle and PVAD assisting the right ventricle (LCF + RPF). The numerical model can well reproduce patients' baseline. The cardiac output increases in both assisted configurations (RCF + LPF: +17%, LCF + RPF: +21%, P = ns), left (right) ventricular volumes decrease more evidently in the configuration LCF + RPF (RCF + LPF), left (right) atrial pressure decreases in the LCF + RPF (RCF + LPF) modality. The pulmonary arterial pressure slightly decreases in the configuration LCF + RPF and it increases with RCF + LPF. Left and right ventricular external work increases in both configurations probably because of the total cardiac output increment. However, left and right artero-ventricular coupling improves especially in the LCF + RPF (-36% for the left ventricle and -21% for the right ventricle, P = ns). The pulsatility index decreases by 8.5% in the configuration LCF + RPF and increases by 6.4% with RCF + LPF (P = 0.0001). A numerical model could be useful to tailor on patients the choice of the VAD that could be implanted to improve the hemodynamic benefits. Moreover, a model could permit to simulate extreme physiological conditions and innovative configurations, as the implantation of both CVAD and PVAD on the same patient.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù
| | - Gianfranco Ferrari
- Cardiovascular Engineering, Institute of Clinical Physiology, Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù
| | - Libera Fresiello
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Paolo Guccione
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù
| | - Alessandra Toscano
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù
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Chopski SG, Moskowitz WB, Stevens RM, Throckmorton AL. Mechanical Circulatory Support Devices for Pediatric Patients With Congenital Heart Disease. Artif Organs 2016; 41:E1-E14. [DOI: 10.1111/aor.12760] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Steven G. Chopski
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA
| | - William B. Moskowitz
- Division of Pediatric Cardiology, Children's Hospital of Richmond and School of Medicine; Virginia Commonwealth University; Richmond VA
| | - Randy M. Stevens
- St. Christopher's Hospital for Children, Tenet Healthcare Corporation; Philadelphia PA USA
| | - Amy L. Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA
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Rosenthal DN, Almond CS, Jaquiss RD, Peyton CE, Auerbach SR, Morales DR, Epstein DJ, Cantor RS, Kormos RL, Naftel DC, Butts RJ, Ghanayem NS, Kirklin JK, Blume ED. Adverse events in children implanted with ventricular assist devices in the United States: Data from the Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS). J Heart Lung Transplant 2016; 35:569-77. [PMID: 27197775 DOI: 10.1016/j.healun.2016.03.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/25/2016] [Accepted: 03/11/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Ventricular assist devices (VADs) have been used in children on an increasing basis in recent years. One-year survival rates are now >80% in multiple reports. In this report we describe adverse events experienced by children with durable ventricular assist devices, using a national-level registry (PediMACS, a component of INTERMACS) METHODS: PediMACS is a national registry that contains clinical data on patients who are <19 years of age at the time of VAD implantation. Data collection concludes at the time of VAD explantation. All FDA-approved devices are included. PediMACS was launched on September 1, 2012, and this report includes all data from launch until August 2014. Adverse events were coded with a uniform, pre-specified set of definitions. RESULTS This report comprises data from 200 patients with a median age of 11 years (range 11 days to 18 years), and total follow-up of 783 patient-months. The diagnoses were cardiomyopathy (n = 146, 73%), myocarditis (n = 17, 9%), congenital heart disease (n = 35, 18%) and other (n = 2, 1%). Pulsatile-flow devices were used in 91 patients (45%) and continuous-flow devices in 109 patients (55%). Actuarial survival was 81% at 6 months. There were 418 adverse events reported. The most frequent events were device malfunction (n = 79), infection (n = 78), neurologic dysfunction (n = 52) and bleeding (n = 68). Together, these accounted for 277 events, 66% of the total. Although 38% of patients had no reported adverse event and 16% of patients had ≥5 adverse events. Adverse events occurred at all time-points after implantation, but were most likely to occur in the first 30 days. For continuous-flow devices, there were broad similarities in adverse event rates between this cohort and historic rates from the INTERMACS population. CONCLUSIONS In this study cohort, the overall rate of early adverse events (within 90 days of implantation) was 86.3 events per 100 patient-months, and of late adverse events it was 20.4 events per 100 patient-months. The most common adverse events in recipients of pulsatile VADs were device malfunction, neurologic dysfunction, bleeding and infection. For continuous-flow VADs, the most common adverse events were infection, bleeding, cardiac arrhythmia, neurologic dysfunction and respiratory failure. Compared with an adult INTERMACS cohort, the overall rate and distribution of adverse events appears similar.
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Affiliation(s)
- David N Rosenthal
- Department of Pediatric (Cardiology), Stanford University, Palo Alto, California, USA.
| | - Christopher S Almond
- Department of Pediatric (Cardiology), Stanford University, Palo Alto, California, USA
| | - Robert D Jaquiss
- Department of Pediatric Cardiac Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christine E Peyton
- Children's Hospital Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Scott R Auerbach
- Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - David R Morales
- Department of Pediatric Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Deirdre J Epstein
- Department of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan S Cantor
- Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert L Kormos
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David C Naftel
- Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ryan J Butts
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nancy S Ghanayem
- Department of Pediatrics (Critical Care Section), Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - James K Kirklin
- Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
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Shehab S, Newton PJ, Allida SM, Jansz PC, Hayward CS. Biventricular mechanical support devices--clinical perspectives. Expert Rev Med Devices 2016; 13:353-65. [PMID: 26894825 DOI: 10.1586/17434440.2016.1154454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac transplantation remains the optimal treatment for end stage heart failure in selected patients. However, the shortage of donor hearts, rigorous eligibility criteria and long waiting lists have increased the demand for alternative treatment strategies such as mechanical circulatory support. While many patients are adequately supported with left ventricular assist devices, frequently there is right heart failure or involvement of the right ventricle, requiring biventricular support. Pulsatile flow biventricular devices and total artificial hearts approved for temporary biventricular support have limitations including size, high rates of adverse events and restricted mobility which makes them unsuitable for long term support. A number of centres have reported dual continuous flow left ventricular assist devices as a means of supporting the left and right heart. This review will summarise the literature on the outcomes and complications from current biventricular support devices and assess the role of dual continuous flow VAD therapy, and the new continuous flow total heart replacement devices.
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Affiliation(s)
- Sajad Shehab
- a Centre for Cardiovascular & Chronic Care, Faculty of Health , University of Technology , Sydney , Australia.,b Cardiology Department , St. Vincent's Hospital , Darlinghurst , Australia
| | - Phillip J Newton
- a Centre for Cardiovascular & Chronic Care, Faculty of Health , University of Technology , Sydney , Australia
| | - Sabine M Allida
- a Centre for Cardiovascular & Chronic Care, Faculty of Health , University of Technology , Sydney , Australia
| | - Paul C Jansz
- b Cardiology Department , St. Vincent's Hospital , Darlinghurst , Australia
| | - Christopher S Hayward
- b Cardiology Department , St. Vincent's Hospital , Darlinghurst , Australia.,c Victor Chang Cardiac Research Institute , Darlinghurst , Australia.,d Faculty of Medicine , University of New South Wales , Kensington , Australia
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16
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Litmathe J, Dafotakis M, Sucker C, Schulz JB. Cardiovascular causes of emergency neurology presenting to an ICU. Perfusion 2015; 31:271-80. [PMID: 26494486 DOI: 10.1177/0267659115613429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stroke or transient ischemic attacks (TIA) represent an urgent clinical entity that is not limited only to elderly patients. The underlying causes of stroke and TIA are diverse, with those of cardiovascular origin being among the most prominent. This review seeks to elucidate some of the most important aspects of the disease in the context of emergency and critical care practice.
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Affiliation(s)
- Jens Litmathe
- Department of Neurology, RWTH University, Aachen, Germany
| | | | | | - Jörg B Schulz
- Department of Neurology, RWTH University, Aachen, Germany Jülich Aachen Research Alliance (JARA) - Translational Brain Medicine, Aachen, Germany
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17
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Costello JP, Diab YA, Philippe-Auguste M, Jones MB, Shankar V, Friedman KD, Nath DS. Acquired von Willebrand syndrome in a child following Berlin Heart EXCOR Pediatric Ventricular Assist Device implantation: case report and concise literature review. World J Pediatr Congenit Heart Surg 2015; 5:592-8. [PMID: 25324261 DOI: 10.1177/2150135114539521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The development of acquired von Willebrand syndrome (AVWS) after placement of a pulsatile-flow left ventricular assist device (LVAD) is rare and only recently recognized. We report the case of a young infant who was diagnosed with ventricular assist device (VAD)-related AVWS following implantation of a Berlin Heart EXCOR Pediatric Ventricular Assist Device (Berlin Heart Inc., The Woodlands, Texas, USA) for treatment of severe heart failure. Despite significant bleeding, the patient was successfully managed with von Willebrand factor-containing concentrate until VAD explantation led to definitive resolution of the AVWS. This case demonstrates that the possibility of this diagnosis should be considered in pediatric patients when extensive, nonsurgical bleeding is encountered after pulsatile-flow VAD implantation.
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Affiliation(s)
- John P Costello
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Yaser A Diab
- Department of Hematology, Children's National Health System, Washington, DC, USA
| | | | - Melissa B Jones
- Department of Critical Care Medicine, Children's National Health System, Washington, DC, USA
| | - Venkat Shankar
- Department of Critical Care Medicine, Children's National Health System, Washington, DC, USA
| | - Kenneth D Friedman
- Hemostasis Reference Laboratory, Blood Center of Wisconsin, Milwaukee, WI, USA
| | - Dilip S Nath
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
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18
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Conway J, St. Louis J, Morales DL, Law S, Tjossem C, Humpl T. Delineating Survival Outcomes in Children <10 kg Bridged to Transplant or Recovery With the Berlin Heart EXCOR Ventricular Assist Device. JACC-HEART FAILURE 2015; 3:70-77. [DOI: 10.1016/j.jchf.2014.07.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 07/17/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
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Abstract
BACKGROUND Children with myocarditis have multiple risk factors for thrombotic events, yet the role of antithrombotic therapy is unclear in this population. We hypothesised that thrombotic events in critically ill children with myocarditis are common and that children with myocarditis are at higher risk for thrombotic events than children with non-inflammatory dilated cardiomyopathy. METHODS This is a retrospective chart review of all children presenting to a single centre cardiac intensive care unit with myocarditis from 1995 to 2008. A comparison group of children with dilated cardiomyopathy was also examined. Antithrombotic regimens were recorded. The primary outcome of thrombotic events included intracardiac clots and any thromboembolic events. RESULTS Out of 45 cases with myocarditis, 40% were biopsy-proven, 24% viral polymerase chain reaction-supported, and 36% diagnosed based on high clinical suspicion. There were two (4.4%) thrombotic events in the myocarditis group and three (6.7%) in the dilated cardiomyopathy group (p = 1.0). Neither the use of any antiplatelet or anticoagulation therapy, use of intravenous immune globulin, presence of any arrhythmia, nor need for mechanical circulatory support were predictive of thrombotic events in the myocarditis, dilated cardiomyopathy, or combined groups. CONCLUSIONS Thrombotic events in critically ill children with myocarditis and dilated cardiomyopathy occurred in 6% of the combined cohort. There was no difference in thrombotic events between inflammatory and non-inflammatory cardiomyopathy groups, suggesting that the decision to use antithrombotic prophylaxis should be based on factors other than the underlying aetiology of a child's acute decompensated heart failure.
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20
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Pump size of Berlin Heart EXCOR pediatric device influences clinical outcome in children. J Heart Lung Transplant 2014; 33:816-21. [DOI: 10.1016/j.healun.2014.03.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/19/2014] [Accepted: 03/24/2014] [Indexed: 01/26/2023] Open
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Davies RR, Haldeman S, McCulloch MA, Pizarro C. Creation of a quantitative score to predict the need for mechanical support in children awaiting heart transplant. Ann Thorac Surg 2014; 98:675-82; discussion 682-4. [PMID: 24968767 DOI: 10.1016/j.athoracsur.2014.04.087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/11/2014] [Accepted: 04/21/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Due to the availability of new devices, the use of ventricular assist devices (VADs) in children has been increasing; however, patient selection and optimal timing of device implantation in this population remains uncertain. METHODS A retrospective review of the United Network for Organ Sharing dataset identified 5,200 listings without mechanical circulatory support (MCS) for isolated pediatric heart transplant, 1995 to 2012. Patients were randomly divided into a derivation and validation cohort. A multivariable logistic regression model predicting the likelihood of death or need for MCS within 60 days was built using the derivation cohort and tested in the validation cohort. A simplified score (PedsMCS score) was developed and evaluated for accuracy. RESULTS The predictive model consisted of variables present at listing (age, albumin level, creatinine clearance, serum bilirubin, mechanical ventilation, and inotropic support). It had good predictive ability (C statistic 0.7304) within the validation cohort. The simplified PedsMCS score was also predictive (C statistic 0.7217) and there was a strong correlation between predicted and expected outcomes (r=0.91, p<0.0001). Patients with PedsMCS score 16 or greater had a significantly higher risk of death or MCS within 2 months (36.6%) than those with low scores (<6) (1.5%, p<0.0001). A single point increase in PedsMCS score was associated with a 16.7% increase in the risk of death or MCS with 2 months (p<0.0001). CONCLUSIONS We have developed and validated a simplified score to predict the need for MCS based on risk factors present at listing. This will provide more accurate prognostication in children awaiting heart transplant, and may improve patient selection.
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Affiliation(s)
- Ryan R Davies
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware; Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Shylah Haldeman
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware
| | - Michael A McCulloch
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware; Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christian Pizarro
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware; Thomas Jefferson University, Philadelphia, Pennsylvania
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Abstract
In this Editor's Review, articles published in 2013 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, the International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level". Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide so meaningful suggestions to the author's work whether eventually accepted or rejected and especially to those whose native tongue is not English. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, Wiley Periodicals, for their expert attention and support in the production and marketing of Artificial Organs. We look forward to recording further advances in the coming years.
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Davies RR, Haldeman S, McCulloch MA, Pizarro C. Ventricular assist devices as a bridge-to-transplant improve early post-transplant outcomes in children. J Heart Lung Transplant 2014; 33:704-12. [PMID: 24709269 DOI: 10.1016/j.healun.2014.02.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 02/03/2014] [Accepted: 02/07/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The use of ventricular assist devices (VADs) to bridge pediatric patients to transplant or recovery has been expanding. There are few current pediatric data assessing the impact of VAD support on post-transplant survival. METHODS We performed a retrospective review of all pediatric (≤18 years old, n = 4,028) transplants performed between 1995 and 2011 and contained within the United Network for Organ Sharing data set. Transplants were divided into three eras: early (1995 to 2002, n = 1,450); intermediate (2003 to 2007, n = 1,138); and recent (2008 to 2011, n = 1,440). VADs were present at transplant in 398 patients (9.8%). Outcomes among patients with and without VADs were assessed and compared across eras. RESULTS The use of VADs for bridge to transplant has increased (early 1.1%, intermediate 10.5%, recent 17.9%; p < 0.0001). Mean weight among VAD-supported patients (early 63.5 kg, intermediate 42.3 kg, recent 28.8 kg; p < 0.0001) has decreased during this period. VAD patients <10 kg had an increased risk of stroke (odds ratio [OR] = 4.9, 95% confidence interval [CI] 2.1 to 10.8) compared with non-mechanical support patients. In multivariable analyses, extracorporeal VADs were the only type of VAD associated with higher post-transplant mortality (OR = 3.0, 95% CI 0.8 to 10.6). Other types of VAD had lower mortality (OR = 0.5, 95% CI 0.2 to 1.0). Long-term survival was unaffected by the use of a VAD pre-transplant. CONCLUSIONS Pediatric patients bridged to transplantation with VADs are increasingly younger and smaller. Complication rates remain high among patients <10 kg. Early post-transplant survival among intracorporeal and paracorporeal VAD patients is excellent and better when compared with unsupported patients. The use of short-term support devices is associated with higher post-transplant mortality. Long-term survival is unaffected by VAD use.
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Affiliation(s)
- Ryan R Davies
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware; Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Shylah Haldeman
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware
| | - Michael A McCulloch
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware; Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christian Pizarro
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware; Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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