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Iacobelli R, Di Molfetta A, Amodeo A. Echocardiographic imaging and ventricular mechanics in pulsatile-flow LVAD pediatric patients: a systematic approach. Front Pediatr 2024; 12:1345891. [PMID: 38348212 PMCID: PMC10860755 DOI: 10.3389/fped.2024.1345891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
Echocardiography plays a crucial role in determining the eligibility for left ventricular assist device (LVAD) placement in patients experiencing advanced heart failure (HF) and in monitoring patient care after the implantation procedure. Because of its unique nature, pediatric population and pulsatile-flow LVADs used in pediatrics require specific skills so that pediatric echocardiographers must develop a systematic approach in order to image the patients pre and post LVAD implantation. Therefore, the purpose of this narrative review is to delineate a systematic echocardiographic approach for pediatric patients supported by pulsatile-flow LVADs.
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Affiliation(s)
- R. Iacobelli
- Pediatric Cardiology Unit, Clinical Area of Fetal and Cardiovascular Science, Bambino Gesù Children’s Hospital, Rome, Italy
| | - A. Di Molfetta
- Cathetherization Laboratory, Fabrizio Spaziani Hospital, Frosinone, Italy
| | - A. Amodeo
- Heart Failure Unit, Cardiac Transplantation and MCS, Clinical Area of Fetal and Cardiovascular Science, Bambino Gesù Children’s Hospital, Rome, Italy
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Fan L, Choy JS, Lee S, Campbell KS, Wenk JF, Kassab GS, Burkhoff D, Lee LC. An in silico study of the effects of left ventricular assist device on right ventricular function and inter-ventricular interaction. Artif Organs 2023; 47:1831-1847. [PMID: 37746896 PMCID: PMC10964177 DOI: 10.1111/aor.14649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Left ventricular assist device (LVAD) is associated with a high incidence of right ventricular (RV) failure, which is hypothesized to be caused by the occurring inter-ventricular interactions when the LV is unloaded. Factors contributing to these interactions are unknown. METHODS We used computer modeling to investigate the impact of the HeartMate 3 LVAD on RV functions. The model was first calibrated against pressure-volume (PV) loops associated with a heart failure (HF) patient and validated against measurements of inter-ventricular interactions in animal experiments. The model was then applied to investigate the effects of LVAD on (1) RV chamber contractility indexed byV 60 derived from its end-systolic PV relationship, and (2) RV diastolic function indexed byV 20 derived from its end-diastolic PV relationship. We also investigated how septal wall thickness and regional contractility affect the impact of LVAD on RV function. RESULTS The impact of LVAD on RV chamber contractility is small at a pump speed lower than 4k rpm. At a higher pump speed between 4k and 9k rpm, however, RV chamber contractility is reduced (by ~3% at 6k rpm and ~10% at 9k rpm). The reduction of RV chamber contractility is greater with a thinner septal wall or with a lower myocardial contractility at the LV free wall, septum, or RV free wall. CONCLUSION RV chamber contractility is reduced at a pump speed higher than 4k rpm, and this reduction is greater with a thinner septal wall or lower regional myocardial contractility. Findings here may have clinical implications in identifying LVAD patients who may suffer from RV failure.
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Affiliation(s)
- Lei Fan
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jenny S. Choy
- California Medical Innovations Institute, San Diego, California, USA
| | - Sangjin Lee
- Division of Medicine, Advanced Heart Failure and Transplantation, Spectrum Health Meijer Heart & Vascular Institute, Grand Rapids, Michigan, USA
| | - Kenneth S. Campbell
- Physiology and Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jonathan F. Wenk
- Department of Mechanical Engineering, University of Kentucky, Lexington, Kentucky, USA
| | - Ghassan S. Kassab
- California Medical Innovations Institute, San Diego, California, USA
| | | | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan, USA
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Designing an Active Valvulated Outflow Conduit for a Continuous-Flow Left Ventricular Assist Device to Increase Pulsatility: A Simulation Study. ASAIO J 2021; 67:529-535. [PMID: 33902101 DOI: 10.1097/mat.0000000000001255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this work was to investigate, using a lumped parameter model, the feasibility of increasing the pulsatility of a continuous-flow ventricular assist device (VAD) by implanting an active valvulated outflow cannula. A lumped parameter model was adopted for this study. VAD was modeled, starting from its pressure-flow characteristics. The valvulated outflow conduit was modeled as an active resistance described by a square function. Starting from pathologic condition, the following simulations were performed: VAD, VAD and valvulated outflow conduit in copulsation and counterpulsation with different ratios between the VAD valve opening rate and the heart rate, and asynchrony work with the heart with different VAD valve opening intervals. The copulsation 1:1 configuration and the asynchrony 0.3s-close-0.7s-open configurations permit to maximize the hemodynamic benefits provided by the presence of the active VAD outflow valvulated conduit providing an increase of arterial pulsatility from 1.86% to 14.98% without the presence of left ventricular output. The presence of the active VAD valve in the outflow conduit causes a decrement of the left ventricular unloading and of VAD flow and, that can be counteracted by increasing the VAD speed without affecting arterial pulsatility. The valvulated outflow tube provides an increase in arterial pulsatility; it can be driven in different working modality and can be potentially applicable to all types of VADs. However, the valvulated outflow conduit causes a decrement of left ventricular unloading and of the VAD flow that can be counteracted, increasing the VAD speed.
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Sensitivity Analysis of Single Beat Left Ventricular Elastance Estimation by Chen Method. Cardiovasc Eng Technol 2021; 13:139-146. [PMID: 34159533 DOI: 10.1007/s13239-021-00556-5] [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: 01/29/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Left ventricular (LV) end-systolic elastance (Ees) can be estimated using single-beat (Ees(sb)) Chen method, employing systolic and diastolic arm-cuff pressures, stroke volume (SV), ejection fraction and estimated normalized ventricular elastance at arterial end-diastole. This work aims to conduct a sensitivity analysis of Chen formula to verify its reliability and applicability in clinical scenario. METHODS Starting from a baseline condition, we evaluated the sensitivity of Ees(sb) to the parameters contained in the formula. Moreover, a mathematical model of the cardiovascular system was used to evaluate the sensitivity of Ees(sb) to end-diastolic LV elastance (Eed), Ees, arterial systemic resistance (Ras) and heart rate (HR). RESULTS In accordance with Ees definition, Ees(sb) increases by increasing aortic pressure and pre-ejection time, reaching the highest value for a pre-ejection time = 40 ms, and then decreases. In contrast with Ees definition, Ees(sb) increases (from 3.21 mmHg/mL to 12.15 mmHg/mL) by increasing the LV end-systolic volume and decreases by increasing the SV. In the majority of the analysis with the mathematical model, Ees was underestimated using the Chen method: by increasing Ees (from 0.5 to 2.5 mmHg/mL), Ees(sb) passes only from 0.56 to 1.54 mmHg/mL. Ees(sb) increases for higher Eed (from 1.03 to 2.33 mmHg/mL). Finally, Ees(sb) decreases (increases) for HR < 50 bpm (< 50 bpm), and for Ras < 1100 mmHg/gcm4 (> 1100 mmHg/gcm4). CONCLUSION Unexpectedly Ees(sb) increases for higher LV end-systolic volume and decreases for higher SV. These results contrast with Ees definition, which is the ratio between the LV end-systolic pressure and the LV end-systolic volume. Moreover, Ees(sb) is influenced by cardiocirculatory parameters such as LV Eed, HR, Ras, ejection time, and pre-ejection time. Finally, Ees(sb) computed with the model output often underestimates model Ees.
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Di Molfetta A, Cusimano V, Ferrari G. Increasing the pulsatility of continuos flow VAD: comparison between a valvulated outflow cannula and speed modulation by simulation. J Artif Organs 2021; 24:146-156. [PMID: 33512579 DOI: 10.1007/s10047-020-01235-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
To investigate by a lumped parameter model the feasibility of increasing the pulsatility of a continuous flow VAD, implanting an active valvulated outflow cannula and to compare the results with the haemodynamic outcome given by speed modulation methods. The concomitant presence of speed modulation and the active valvulated outflow conduit is also simulated. A lumped parameter model was adopted. VAD was modeled starting from its pressure flow characteristics with a second order polynomial equation. The valvulated outflow conduit was modeled as an active resistance described by a square function. Starting from pathological condition we simulated: VAD; VAD and valvulated outflow conduit in copulsation, counterpulsation and asynchrony work with the heart; VAD and active valvulated outflow tube and speed modulation. Copulsation 1:1 and asynchrony 0.3 s valve close-0.7 s valve open configurations maximised the haemodynamic benefits with the highest increment in pulsatility. The valvulated outflow conduit causes a decrement of the left ventricular unloading and of VAD flow that can be counteracted by increasing the VAD speed without affecting pulsatility. The concomitant use of the speed modulation and the active valvulated outflow conduit can further increase the pulsatility without altering left ventricular unloading and VAD flow. The valvulated outflow tube provide similar increase in pulsatility to speed modulation method but causes a decrement of left ventricular unloading and VAD flow that can be counteracted increasing the VAD speed or allowing a partial support. A valvulated outflow tube can be potentially applied to all continuous flow VADs.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Cardiac Surgery, Policlinico Gemelli Hospital, Largo Agostino Gemelli, 8, 00100, Rome, Italy.
| | - Valerio Cusimano
- CNR-IASI BioMatLab, Italian National Research Council, Institute of Analysis, Systems and Computer Science, Biomathematics Laboratory, Rome, Italy
| | - Gianfranco Ferrari
- Institute of Biocybernetics and Biomedical Engineer, Polish Academy of Science, Warsaw, Poland
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Di Molfetta A, Adachi I, Ferrari G, Gagliardi MG, Perri G, Iacobelli R, Qureshi AM, Di Pasquale L, Vera RZ, Guccione P, Di Molfetta M, Chiariello GA, Filippelli S, Amodeo A. Left ventricular unloading during extracorporeal membrane oxygenation – Impella versus atrial septal defect: A simulation study. Int J Artif Organs 2020; 43:663-670. [DOI: 10.1177/0391398820906840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Atrial septal defect and Impella have been proposed for left ventricular unloading in venoarterial extracorporeal membrane oxygenation patients. This work aims at evaluating the haemodynamic changes in venoarterial extracorporeal membrane oxygenation patients after Impella implantation or atrial septal defect realization by a simulation study. Methods: A lumped parameter model of the cardiovascular system was adapted to this study. Atrial septal defect was modelled as a resistance between the two atria. Venoarterial extracorporeal membrane oxygenation and Impella were modelled starting from their pressure-flow characteristics. The baseline condition of a patient undergoing venoarterial extracorporeal membrane oxygenation was reproduced starting from haemodynamic and echocardiographic data. The effects of different atrial septal defect size, Impella and venoarterial extracorporeal membrane oxygenation support were simulated. Results: Impella caused an increment of mean arterial pressure up to 67%, a decrement in mean pulmonary arterial pressure up to 8%, a decrement in left ventricular end systolic volume up to 11% with a reduction up to 97% of left ventricular cardiac output. Atrial septal defect reduces left atrial pressure (19%), increases right atrial pressure (22%), increases mean arterial pressure (18%), decreases left ventricular end systolic volume (11%), increases right ventricular volume (33%) and decreases left ventricular cardiac output (55%). Conclusion: Impella has a higher capability in left ventricular unloading during venoarterial extracorporeal membrane oxygenation in comparison to atrial septal defect with a lower right ventricular overload.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Cardiac Surgery, Policlinico Gemelli-Catholic University of Rome, Rome, Italy
| | - Iki Adachi
- Department of Cardiac Surgery and The Lillie Frank Abercrombie Section of Cardiology, Texas Heart Hospital, Texas Children’s Hospital, Houston, TX, USA
| | - Gianfranco Ferrari
- Nalecz Institute of Biocybernetics and Biomedical Engineering (IBBE) PAS, Warszawa, Poland
| | - Maria Giulia Gagliardi
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Gianluigi Perri
- Department of Cardiac Surgery, Policlinico Gemelli-Catholic University of Rome, Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Athar M Qureshi
- Department of Cardiac Surgery and The Lillie Frank Abercrombie Section of Cardiology, Texas Heart Hospital, Texas Children’s Hospital, Houston, TX, USA
| | - Luigi Di Pasquale
- Department of Cardiac Surgery and The Lillie Frank Abercrombie Section of Cardiology, Texas Heart Hospital, Texas Children’s Hospital, Houston, TX, USA
| | - Rodrigo Zea Vera
- Department of Cardiac Surgery and The Lillie Frank Abercrombie Section of Cardiology, Texas Heart Hospital, Texas Children’s Hospital, Houston, TX, USA
| | - Paolo Guccione
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Matteo Di Molfetta
- Department of Cardiac Surgery, Policlinico Gemelli-Catholic University of Rome, Rome, Italy
| | | | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
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Iacobelli R, Di Molfetta A, Cobianchi Bellisari F, Toscano A, Filippelli S, Di Chiara L, Pasquini L, Iorio FS, Amodeo A. Changes in left and right ventricular two-dimensional echocardiographic speckle-tracking indices in pediatric LVAD population: A retrospective clinical study. Int J Artif Organs 2019; 42:711-716. [PMID: 31238772 DOI: 10.1177/0391398819857446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Echocardiographic strain and strain-rate imaging is a promising tool for the evaluation of myocardial segmental function, for the early detection of myocardial dysfunction, and for the prediction of reverse remodeling. We aimed at studying the changes in left and right ventricular function in pulsatile left ventricular assist device pediatric patients by two-dimensional echocardiography and two-dimensional speckle-tracking echocardiography. Echocardiographic and clinical data of patients implanted with a pulsatile-flow left ventricular assist device from 2011 to 2018 were retrospectively reviewed before and after implantation at 1, 3, and 6 months. A total of 18 patients were enrolled. Median age and weight at implantation were 9 months (5-23 months) and 5.85 kg (4.85-8.75 kg), respectively; median left ventricular assist device support was 181 (114.5-289.5) days. 13 patients (73%) were transplanted and 5 patients (27%) died. At follow-up: left ventricular ejection fraction increase at 1 month (p = 0.001) and 3 months (p = 0.01), left ventricular global longitudinal strain improvement at 1 month (p = 0.0008) and 3 months (p = 0.02), and right ventricular free-wall longitudinal strain increase at 1 month (p = 0.01). At short term after left ventricular assist device implantation, both left ventricular and right ventricular mechanics improved. The temporary benefit seems to decrease over time. The worsening of left ventricular function has been followed by a worsening of right ventricular function probably due to the ventricular interdependence.
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Affiliation(s)
- Roberta Iacobelli
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Arianna Di Molfetta
- Department of Cardiac Surgery, Policlinico Universitario A. Gemelli, Rome, Italy
| | | | - Alessandra Toscano
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Sergio Filippelli
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Luca Di Chiara
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Luciano Pasquini
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Fiore Salvatore Iorio
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Antonio Amodeo
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
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Ferrari G, Di Molfetta A, Zieliński K, Fresiello L, Górczyńska K, Pałko KJ, Darowski M, Amodeo A, Kozarski M. Control of a Pediatric Pulsatile Ventricular Assist Device: A Hybrid Cardiovascular Model Study. Artif Organs 2017. [DOI: 10.1111/aor.12929] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Gianfranco Ferrari
- CNR, Institute of Clinical Physiology; Pediatric Hospital Bambino Gesù; Rome Italy
| | - Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardio Surgery; Pediatric Hospital Bambino Gesù; Rome Italy
| | - Krzysztof Zieliński
- Nałecz Institute of Biocybernetics and Biomedical Engineering; PAS; Warsaw Poland
| | - Libera Fresiello
- CNR, Institute of Clinical Physiology; Pediatric Hospital Bambino Gesù; Rome Italy
- Department of Cardiac Surgery; Catholic University of Leuven; Leuven Belgium
| | - Krystyna Górczyńska
- Nałecz Institute of Biocybernetics and Biomedical Engineering; PAS; Warsaw Poland
| | | | - Marek Darowski
- Nałecz Institute of Biocybernetics and Biomedical Engineering; PAS; Warsaw Poland
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardio Surgery; Pediatric Hospital Bambino Gesù; Rome Italy
| | - Maciej Kozarski
- Nałecz Institute of Biocybernetics and Biomedical Engineering; PAS; Warsaw Poland
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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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Di Molfetta A, Gandolfo F, Filippelli S, Perri G, Di Chiara L, Iacobelli R, Adorisio R, Favia I, Rizza A, Testa G, Di Nardo M, Amodeo A. The Use of Berlin Heart EXCOR VAD in Children Less than 10 kg: A Single Center Experience. Front Physiol 2016; 7:614. [PMID: 27999550 PMCID: PMC5138210 DOI: 10.3389/fphys.2016.00614] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 11/24/2016] [Indexed: 12/23/2022] Open
Abstract
Objective: Despite the improvement in ventricular assist device (VAD) therapy in adults and in adolescents, in infant population only Berlin Heart EXCOR (BHE) is licensed as long term VAD to bridge children to Heart Transplantation (HTx). Particularly demanding in terms of morbidity and mortality are smallest patients namely the ones implanted in the first year of life or with a lower body surface area. This work aims at retrospective reviewing a single center experience in using BHE in children with a body weight under 10 kg. Methods: Data of all pediatric patients under 10 kg undergoing BHE implantation in our institution from March 2002 to March 2016 were retrospectively reviewed. Results: Of the 30 patients enrolled in the study, 53% were male, 87% were affected by a dilated cardiomyopathy with an average weight and age at the implantation of 6.75 ± 2.16 Kg and 11.57 ± 10.12 months, respectively. Three patients (10%) required a BIVAD implantation. After the implantation, 7 patients (23%) required re-intervention for bleeding and 9 patients (30%) experienced BHE cannulas infection. A total of 56 BHE pump were changed for thrombus formation (1.86 BHE pump for patient). The average duration of VAD support was 132.8 ± 94.4 days. Twenty patients (67%) were successfully transplanted and 10 patients (33%) died: 7 for major neurological complication and 3 for sepsis. Conclusion: Mechanical support in smaller children with end stage heart failure is an effective strategy for bridging patients to HTx. The need for BIVAD was relegated, in the last years, only to restrictive cardiomiopathy. Further efforts are required in small infants to improve anticoagulation strategy to reduce neurological events and BHE pump changes.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Fabrizio Gandolfo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Luca Di Chiara
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Rachele Adorisio
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Isabella Favia
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Alessandra Rizza
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Giuseppina Testa
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Matteo Di Nardo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
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