The Combined Use of Extracorporeal Life Support and the Berlin Heart Pulsatile Pediatric Ventricular Assist Device as a Bridge to Transplant in a Toddler

¹ Department of Clinical Perfusion, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
² Division of Cardiovascular Surgery, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
³ Division of Cardiology, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
⁴ Department of Pediatric Intensive Care Unit, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
⁵ Department of Anesthesia, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada

^* Address correspondence to: Dominique Shum-Tim, MD, Cardiovascular Surgery, The Montreal Children’s Hospital, 2300 Tupper Street, Room C-829, Montreal, Quebec, Canada, H3H 1P3. E-mail: dominique.shum-tim@muhc.mcgill.ca

Abstract

There is a very limited published material about experience with long-term pediatric mechanical circulatory support as a bridge to heart transplant. We report on a 2-year-old, 12 kg boy admitted with 2-week history of low-grade fever, ear pain, pulmonary edema, and congestive heart failure. Trans-thoracic echocardiography confirmed severe myocardial dysfunction with a left ventricular ejection fraction of 0.20 and percentage shortening of 13. After 2 days of ventilatory and inotropic support, the patient continued to deteriorate and subsequently required femoro–femoral extracorporeal life support (ECLS). This was later complicated by a progressive coagulopathy and massive bleeding. On day 17, a pulsatile pediatric paracorporeal biventricular assist device (VAD) (Berlin Heart) was implanted. The patient’s condition improved significantly with all coagulopathies corrected, and the patient was extubated 21 days later. After 109 days of bi-VAD support, the patient was successfully transplanted and discharged home 45 days post transplant. Our early experience with initial ECLS bridge to VAD and subsequently to transplant was encouraging. It allowed for additional time to select the ideal organ donor and optimize the recipient’s comorbid condition and multiorgan failure. VAD provides an additional armamentarium of circulatory support in pediatric patients with severe heart failure.