Successful explantation of children from the Berlin Heart EXCOR® ventricular assist device: A systematic review

Matthew F Mikulski; Swati Iyer; Andrew Well; Carlos M Mery; W Richard Owens; Lauren D Glass; Chesney D Castleberry; Charles D Fraser Jr

doi:10.1111/aor.14727

Successful explantation of children from the Berlin Heart EXCOR® ventricular assist device: A systematic review

Artif Organs. 2024 May;48(5):444-455. doi: 10.1111/aor.14727. Epub 2024 Feb 29.

Authors

Matthew F Mikulski^{1

2}, Swati Iyer^{1

2}, Andrew Well^{1

2}, Carlos M Mery^{1

2}, W Richard Owens^{1

2}, Lauren D Glass^{1

3}, Chesney D Castleberry^{1

3}, Charles D Fraser Jr^{1

2

3}

Affiliations

¹ Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Texas, USA.
² Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA.
³ Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA.

PMID: 38419587
DOI: 10.1111/aor.14727

Abstract

Background: The Berlin Heart EXCOR® (BHE) can bridge children with severe heart failure to transplantation, but some are successfully weaned and spared transplantation. This study seeks to identify characteristics of children amenable to successful explantation with BHE support.

Methods: Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines were used. Five databases were screened for original, English articles measuring BHE support in patients <18 years old based on title and abstract. Exclusion criteria were applied: full-text availability, <10 total pediatric BHE patients, zero successful explantations from BHE, nonprimary literature, adult and pediatric results that could not be separated, and studies with overlapping patient information. Studies were analyzed with descriptive statistics.

Results: From 41 857 potential studies, 14 were analyzed with data from 58 hospitals on four continents from 1990 to 2020. There were 984 BHE patients. The most common diagnosis was dilated cardiomyopathy (n = 318, 32.3%), followed by congenital heart disease (n = 249, 25.3%). There were 85 (8.6%) children explanted with favorable outcomes. The underlying diagnosis was known in 44 (51.8%) cases: 14 (8.4%) of 166 cardiomyopathies, 17 (48.6%) of 35 myocarditis, and 12 (16.7%) of 72 with congenital heart disease were explanted. When the type of support was known, the rate of LVAD patients explanted was 21.3% (n = 19/89) and 2.4% (n = 1/42) of BiVAD patients were explanted.

Conclusion: Explantation from BHE is not uncommon at 8.6%, but significant variation exists in the explantation data reported. Myocarditis and LVAD support may be populations suitable for weaning. Standardization of reporting measures and prospective registries may help identify patients suitable for this alternative to transplant and help develop weaning protocols.

Keywords: bridge‐to‐recovery; pediatric extracorporeal VAD; successful explantation; systematic review.

Publication types

Systematic Review
Review

MeSH terms

Adolescent
Child
Heart Defects, Congenital*
Heart Failure* / surgery
Heart Transplantation* / methods
Heart-Assist Devices*
Humans
Myocarditis*
Prospective Studies
Retrospective Studies
Treatment Outcome