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

IF 2.2 3区医学 Q3 ENGINEERING, BIOMEDICAL

Artificial organs Pub Date : 2024-02-29 DOI:10.1111/aor.14727

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

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引用次数: 0

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.

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柏林之心 EXCOR® 心室辅助装置的成功拆卸：系统回顾。

背景：柏林心脏EXCOR®（BHE）可以为严重心力衰竭的儿童搭建移植的桥梁，但有些儿童可以成功断奶，免于移植。本研究旨在确定在 BHE 支持下可成功移植的儿童的特征：方法：采用《2020 年系统综述和元分析首选报告项目》指南。结果：从 41 857 项潜在研究中，有 14 项研究表明，在 BHE 支持下，儿童可以成功地进行移植：从 41 857 项潜在研究中，分析了 14 项研究的数据，这些数据来自四大洲的 58 家医院，时间跨度为 1990 年至 2020 年。共有 984 名 BHE 患者。最常见的诊断是扩张型心肌病（318 人，占 32.3%），其次是先天性心脏病（249 人，占 25.3%）。有 85 名（8.6%）患儿接受了手术，结果良好。44例（51.8%）病例的基本诊断是已知的：166例心肌病中有14例（8.4%）、35例心肌炎中有17例（48.6%）、72例先天性心脏病中有12例（16.7%）被切除。在已知支持类型的情况下，LVAD 患者的手术切除率为 21.3%（n = 19/89），BiVAD 患者的手术切除率为 2.4%（n = 1/42）：结论：BHE 引起的心脏骤停并不少见，比例为 8.6%，但所报告的心脏骤停数据存在显著差异。心肌炎和 LVAD 支持可能是适合断血的人群。报告措施的标准化和前瞻性登记可能有助于识别适合这种移植替代方法的患者，并帮助制定断流方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.