Abstract
Although mechanical circulatory support devices in children are primarily utilised as a bridge to transplant, explantation to recovery is possible in selected cases. The purpose of this study is to report our national data of explantation of mechanical circulatory support devices to clinical recovery in children.
Retrospective study performed in two institutions from January 2007 to September 2018 (12 years). All children who had explanation of mechanical circulatory support devices were included. Relevant variables analysed were gender, age, weight at implantation, primary diagnosis, extracorporeal membrane oxygenation (ECMO) pre & post implantation, type of device used, need for bi-ventricular support, cardiopulmonary bypass time (CPB), arrhythmia before explantation and duration of mechanical device support. Primary outcome was survival after explantation. Secondary outcomes were arrhythmia after explantation, renal replacement therapy (RRT) during mechanical circulatory support, neurological complications and eventual need for heart transplantation.
19 children were eligible (females = 42%, mean age = 38 months, mean weight = 15.4 kilograms). Primary diagnosis included cardiomyopathy (n = 6, 31.6%), myocarditis (n = 12, 63.1%) and congenital heart disease (n = 1, 5.3%). 9 children pre-implant (47.4%) and 2 children post-implant (10.5%) required ECMO. Devices used were Berlin Heart (n = 16, 84.2%) and Levitronix (n = 3, 15.8%). Bi-ventricular support was needed in 4 children (21%). Mean CPB was 108.3 minutes. 5 children (26.3%) had arrhythmia pre-explantation. Mean duration of mechanical circulatory support was 43.9 days (range, 6 to 120 days). 17 children survived explantation (89.4%), of which 1 (5.3%) eventually required heart transplantation. RRT was required in 7 children (36.8%). 1 child had arrhythmia post-explantation (5.3%). 5 children had neurological complications (26.3%).
Explantation of mechanical circulatory support devices to clinical recovery is possible in selected cases in children. The option of device explantation or using them as a bridge to recovery should be considered in children especially if the primary diagnosis is myocarditis. This can mitigate the high risk of morbidities associated with their long-term usage as a bridge to transplant.