Bridge to Heart Transplant in Pediatric Patients. Successful Mechanical Cardiac Support with Ventricular Assist Devices (VAD)
Gerardo Naiman1, Horacio Vogelfang1, Luis Quiroga1, Gustavo Sivori1, Ignacio Berra1, Maria del Carmen de la Riba1, Gisela Abad1.
1Heart Transplant Unit, Hospital De Pediatria "Prof. Juan P. Garrahan", Buenos Aires, Argentina
Introduction: Due to the lack of suitable pediatric cardiac donors and the huge mortality during the waiting list, we started to use mechanical ventricular support (MVS) as a bridge to transplant. This MVS provides long time assitance in very young patients.
Method: Since July 2000 to November 2017, 125 pediatric patients were listed for cardiac transplant. Diagnosis were Dilated Cardiomyopathies 41 (80%), Restrictive Cardiomyopathies 6 (14%) and Congenital Heart disease 3 (6%). Since March 2006, we assisted 47 patients, 46 with the EXCORTM Berlin Heart System, that consist in paracorporeal pumps and a pneumatic impulse console IkusTM, and one intrathoracic, with a continuos flow system ( Heart WareTM). Biventricular MVS was in 26 (55%); and Univentricular MVS was in 21 (45%). We began to use a continuos flow intrathoracic device (Heart WareTM). In July 2013 used to provide left ventricular mechanical assistance in a 15 years old male patient, with high pulmonary presure of 70%, managing to descend it to 50%. He was transplanted after 10 months to achieve a I.N.R.2.8-3.5, then AAS or Dipyridamol were given.
Results: Children were assisted with mechanical assistance devices for 3 days to 954 days, with a median time of 150 days. Pumps were changed in 12 patients, due to fibrin and thrombs formation. The age range of assisted patients was 10 to 192 months (X=87) and 6 o to 45 kg of weigth. Since the introduction of this approach the mortality rate in the waiting list dropped 20% (50 to 30%). Survival on MVS was 67%, 27 were transplanted. One patient still remains in MVS, waiting for a suitable donor.Stroke was the most common cause of death during assitance . Complications: Coagulopathie N=10 (26.3%), Infections N=4 (9%), Aortic pseudoaneurism N=1 (2%).
Conclusions: Mechanical ventricular support is an effective system to maintain alive pediatric patients awaiting a suitable heart donor, even for longs periods of time. This approach results in lower mortality rates and let pediatric patients to have a significant clinical improvement before and after heart transplantation.
