Improvement in Survival After Mechanical Circulatory Support With Pneumatic Pulsatile Ventricular Assist Devices in Pediatric Patients Roland Hetzer,

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Presentation transcript:

Improvement in Survival After Mechanical Circulatory Support With Pneumatic Pulsatile Ventricular Assist Devices in Pediatric Patients Roland Hetzer, MD, PhD, Evgenij V. Potapov, MD, Brigitte Stiller, MD, PhD, Yuguo Weng, MD, PhD, Michael Hübler, MD, Julia Lemmer, MD, Vladimir Alexi-Meskishvili, MD, PhD, Matthias Redlin, MD, Frank Merkle, ECCP, Friedrich Kaufmann, Dipl Eng, Ewald Hennig, PhD The Annals of Thoracic Surgery Volume 82, Issue 3, Pages 917-925 (September 2006) DOI: 10.1016/j.athoracsur.2006.03.065 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Berlin Heart pumps with 10 mL and 80 mL stroke volume. (B) Cross-section of the Berlin Heart pump. The Annals of Thoracic Surgery 2006 82, 917-925DOI: (10.1016/j.athoracsur.2006.03.065) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Modes of implantation of the Berlin Heart Excor biventricular assist device. (A) In the earlier period, atrial cannulation was the rule. (B) More recently, apical cannulation was introduced and is now preferred owing to better left ventricular unloading and reduced afterload to the right ventricle. Consequently, in many instances, a left ventricular assist device only is sufficient. The Annals of Thoracic Surgery 2006 82, 917-925DOI: (10.1016/j.athoracsur.2006.03.065) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The set of cannulas available for the Berlin Heart support system. The cannulas differ in diameter, length, and configuration of the tip. The availability of different tips allows blood drainage from the left atrium or the left ventricular apex. The Annals of Thoracic Surgery 2006 82, 917-925DOI: (10.1016/j.athoracsur.2006.03.065) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Number of patients discharged home in the treatment periods. There is a significant increase in the discharge rate for infants less than 1 year old (p = 0.024). (Black bars = died in hospital; gray bars = discharged home; y = year.) The Annals of Thoracic Surgery 2006 82, 917-925DOI: (10.1016/j.athoracsur.2006.03.065) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Hospital discharge rates for different indications for ventricular assist device support in the two treatment periods. There is significant improvement for postcardiotomy heart failure and cardiomyopathy. (Black bars = died in hospital; gray bars = discharged home; CHD = congenital heart disease; CMP = cardiomyopathy; Post-CPB = postcardiotomy heart failure.) The Annals of Thoracic Surgery 2006 82, 917-925DOI: (10.1016/j.athoracsur.2006.03.065) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Analysis of the cumulative mortality in the whole population. Important changes in ventricular assist device design, patient selection, and postoperative care are marked in relation to time. The Annals of Thoracic Surgery 2006 82, 917-925DOI: (10.1016/j.athoracsur.2006.03.065) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Six-month-old girl on left ventricular assist device. The child had dilative cardiomyopathy and was supported for 29 days before successful heart transplantation. (Printed with parents’ permission.) The Annals of Thoracic Surgery 2006 82, 917-925DOI: (10.1016/j.athoracsur.2006.03.065) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions