Biventricular berlin heart EXCOR pediatric use across the United States

Farhan Zafar, John Jefferies, Christine J. Tjossem, Roosevelt Bryant, Robert D.B. Jaquiss, Peter D. Wearden, David N. Rosenthal, Antonio G. Cabrera, Joseph W. Rossano, Tilman Humpl, David L.S. Morales

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background Biventricular assist device (BiVAD) support was a strong predictor of early mortality in the Berlin Heart EXCOR Pediatric investigational device exemption (IDE) study (Assess Safety and Probable Benefit of the EXCOR Pediatric Ventricular Assist Device [VAD]). In adults, it has been identified that 5% to 10% of the VAD population is benefited by BiVAD support over left ventricular assist device (LVAD) support. An analysis of the Berlin Heart study cohort was performed to characterize patients supported with BiVAD, examine risk factors of mortality in this group, and identify subsets of patients in whom BiVAD is associated with survival. Methods All EXCOR Pediatric devices (Berlin Heart, Inc, The Woodlands, TX) placed in North America between May 2007 and December 2010 comprised the study cohort of 204 patients (128 [63%] LVADs and 76 [37%] BiVADs). The following patient cohorts were analyzed to determine the effect of BiVAD use on survival: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 patients, patients with abnormal bilirubin levels, patients who received previous extracorporeal membrane oxygenation (ECMO), and patients with a 10-mL pump size. Results There were more patients with BiVADs in INTERMACS profile 1 (63% compared with 46%; p = 0.018). The incidence of major bleeding, neurologic and renal dysfunction, and infection was similar between BiVAD and LVAD groups. White race, abnormal glomerular filtration rate (GFR), sites with experience of less than 5 implantations, and use of 10-mL pumps were predictors of mortality in patients who received BiVADs. BiVADs were not associated with improved survival in any patient cohort; however, they were associated with increased mortality in patients who had undergone ECMO before receiving a VAD. Conclusions BiVAD support was not associated with improved survival in any identified subset of patients. Although not randomized, these results (which were corrected for multiple possible risk factors) suggest that some children supported with BiVADs might have done better with LVADs alone. Further prospective studies will be needed to identify patient cohorts that will be better served with BIVAD support.

Original languageEnglish (US)
Pages (from-to)1328-1334
Number of pages7
JournalAnnals of Thoracic Surgery
Volume99
Issue number4
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Berlin
Pediatrics
Heart-Assist Devices
Equipment and Supplies
Extracorporeal Membrane Oxygenation
Survival
Mortality
Registries
Cohort Studies
North America
Neurologic Manifestations
Glomerular Filtration Rate
Bilirubin

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Zafar, F., Jefferies, J., Tjossem, C. J., Bryant, R., Jaquiss, R. D. B., Wearden, P. D., ... Morales, D. L. S. (2015). Biventricular berlin heart EXCOR pediatric use across the United States. Annals of Thoracic Surgery, 99(4), 1328-1334. https://doi.org/10.1016/j.athoracsur.2014.09.078

Biventricular berlin heart EXCOR pediatric use across the United States. / Zafar, Farhan; Jefferies, John; Tjossem, Christine J.; Bryant, Roosevelt; Jaquiss, Robert D.B.; Wearden, Peter D.; Rosenthal, David N.; Cabrera, Antonio G.; Rossano, Joseph W.; Humpl, Tilman; Morales, David L.S.

In: Annals of Thoracic Surgery, Vol. 99, No. 4, 01.01.2015, p. 1328-1334.

Research output: Contribution to journalArticle

Zafar, F, Jefferies, J, Tjossem, CJ, Bryant, R, Jaquiss, RDB, Wearden, PD, Rosenthal, DN, Cabrera, AG, Rossano, JW, Humpl, T & Morales, DLS 2015, 'Biventricular berlin heart EXCOR pediatric use across the United States', Annals of Thoracic Surgery, vol. 99, no. 4, pp. 1328-1334. https://doi.org/10.1016/j.athoracsur.2014.09.078
Zafar, Farhan ; Jefferies, John ; Tjossem, Christine J. ; Bryant, Roosevelt ; Jaquiss, Robert D.B. ; Wearden, Peter D. ; Rosenthal, David N. ; Cabrera, Antonio G. ; Rossano, Joseph W. ; Humpl, Tilman ; Morales, David L.S. / Biventricular berlin heart EXCOR pediatric use across the United States. In: Annals of Thoracic Surgery. 2015 ; Vol. 99, No. 4. pp. 1328-1334.
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abstract = "Background Biventricular assist device (BiVAD) support was a strong predictor of early mortality in the Berlin Heart EXCOR Pediatric investigational device exemption (IDE) study (Assess Safety and Probable Benefit of the EXCOR Pediatric Ventricular Assist Device [VAD]). In adults, it has been identified that 5{\%} to 10{\%} of the VAD population is benefited by BiVAD support over left ventricular assist device (LVAD) support. An analysis of the Berlin Heart study cohort was performed to characterize patients supported with BiVAD, examine risk factors of mortality in this group, and identify subsets of patients in whom BiVAD is associated with survival. Methods All EXCOR Pediatric devices (Berlin Heart, Inc, The Woodlands, TX) placed in North America between May 2007 and December 2010 comprised the study cohort of 204 patients (128 [63{\%}] LVADs and 76 [37{\%}] BiVADs). The following patient cohorts were analyzed to determine the effect of BiVAD use on survival: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 patients, patients with abnormal bilirubin levels, patients who received previous extracorporeal membrane oxygenation (ECMO), and patients with a 10-mL pump size. Results There were more patients with BiVADs in INTERMACS profile 1 (63{\%} compared with 46{\%}; p = 0.018). The incidence of major bleeding, neurologic and renal dysfunction, and infection was similar between BiVAD and LVAD groups. White race, abnormal glomerular filtration rate (GFR), sites with experience of less than 5 implantations, and use of 10-mL pumps were predictors of mortality in patients who received BiVADs. BiVADs were not associated with improved survival in any patient cohort; however, they were associated with increased mortality in patients who had undergone ECMO before receiving a VAD. Conclusions BiVAD support was not associated with improved survival in any identified subset of patients. Although not randomized, these results (which were corrected for multiple possible risk factors) suggest that some children supported with BiVADs might have done better with LVADs alone. Further prospective studies will be needed to identify patient cohorts that will be better served with BIVAD support.",
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AU - Zafar, Farhan

AU - Jefferies, John

AU - Tjossem, Christine J.

AU - Bryant, Roosevelt

AU - Jaquiss, Robert D.B.

AU - Wearden, Peter D.

AU - Rosenthal, David N.

AU - Cabrera, Antonio G.

AU - Rossano, Joseph W.

AU - Humpl, Tilman

AU - Morales, David L.S.

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N2 - Background Biventricular assist device (BiVAD) support was a strong predictor of early mortality in the Berlin Heart EXCOR Pediatric investigational device exemption (IDE) study (Assess Safety and Probable Benefit of the EXCOR Pediatric Ventricular Assist Device [VAD]). In adults, it has been identified that 5% to 10% of the VAD population is benefited by BiVAD support over left ventricular assist device (LVAD) support. An analysis of the Berlin Heart study cohort was performed to characterize patients supported with BiVAD, examine risk factors of mortality in this group, and identify subsets of patients in whom BiVAD is associated with survival. Methods All EXCOR Pediatric devices (Berlin Heart, Inc, The Woodlands, TX) placed in North America between May 2007 and December 2010 comprised the study cohort of 204 patients (128 [63%] LVADs and 76 [37%] BiVADs). The following patient cohorts were analyzed to determine the effect of BiVAD use on survival: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 patients, patients with abnormal bilirubin levels, patients who received previous extracorporeal membrane oxygenation (ECMO), and patients with a 10-mL pump size. Results There were more patients with BiVADs in INTERMACS profile 1 (63% compared with 46%; p = 0.018). The incidence of major bleeding, neurologic and renal dysfunction, and infection was similar between BiVAD and LVAD groups. White race, abnormal glomerular filtration rate (GFR), sites with experience of less than 5 implantations, and use of 10-mL pumps were predictors of mortality in patients who received BiVADs. BiVADs were not associated with improved survival in any patient cohort; however, they were associated with increased mortality in patients who had undergone ECMO before receiving a VAD. Conclusions BiVAD support was not associated with improved survival in any identified subset of patients. Although not randomized, these results (which were corrected for multiple possible risk factors) suggest that some children supported with BiVADs might have done better with LVADs alone. Further prospective studies will be needed to identify patient cohorts that will be better served with BIVAD support.

AB - Background Biventricular assist device (BiVAD) support was a strong predictor of early mortality in the Berlin Heart EXCOR Pediatric investigational device exemption (IDE) study (Assess Safety and Probable Benefit of the EXCOR Pediatric Ventricular Assist Device [VAD]). In adults, it has been identified that 5% to 10% of the VAD population is benefited by BiVAD support over left ventricular assist device (LVAD) support. An analysis of the Berlin Heart study cohort was performed to characterize patients supported with BiVAD, examine risk factors of mortality in this group, and identify subsets of patients in whom BiVAD is associated with survival. Methods All EXCOR Pediatric devices (Berlin Heart, Inc, The Woodlands, TX) placed in North America between May 2007 and December 2010 comprised the study cohort of 204 patients (128 [63%] LVADs and 76 [37%] BiVADs). The following patient cohorts were analyzed to determine the effect of BiVAD use on survival: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 patients, patients with abnormal bilirubin levels, patients who received previous extracorporeal membrane oxygenation (ECMO), and patients with a 10-mL pump size. Results There were more patients with BiVADs in INTERMACS profile 1 (63% compared with 46%; p = 0.018). The incidence of major bleeding, neurologic and renal dysfunction, and infection was similar between BiVAD and LVAD groups. White race, abnormal glomerular filtration rate (GFR), sites with experience of less than 5 implantations, and use of 10-mL pumps were predictors of mortality in patients who received BiVADs. BiVADs were not associated with improved survival in any patient cohort; however, they were associated with increased mortality in patients who had undergone ECMO before receiving a VAD. Conclusions BiVAD support was not associated with improved survival in any identified subset of patients. Although not randomized, these results (which were corrected for multiple possible risk factors) suggest that some children supported with BiVADs might have done better with LVADs alone. Further prospective studies will be needed to identify patient cohorts that will be better served with BIVAD support.

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