Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany.
Eur J Cardiothorac Surg. 2022 Dec 2;63(1). doi: 10.1093/ejcts/ezac516.
The Berlin Heart EXCOR (BHE) offers circulatory support across all paediatric ages. Clinically, the necessary care and the outcomes differ in various age groups. The EUROMACS database was used to study age- and size-related outcomes for this specific device.
All patients <19 years of age from the EUROMACS database supported with a BHE between 2000 and November 2021 were included. Maximally selected rank statistics were used to determine body surface area (BSA) cut-off values. Multivariable Cox proportional hazard regression using ridge penalization was performed to identify factors associated with outcomes.
In total, 303 patients were included [mean age: 2.0 years (interquartile range: 0.6-8.0, males: 48.5%)]. Age and BSA were not significantly associated with mortality (n = 74, P = 0.684, P = 0.679). Factors associated with a transplant (n = 175) were age (hazard ratio 1.07, P = 0.006) and aetiology other than congenital heart disease (hazard ratio 1.46, P = 0.020). Recovery rates (n = 42) were highest in patients with a BSA of <0.53 m2 (21.8% vs 4.3-7.6% at 1 year, P = 0.00534). Patients with a BSA of ≥0.73 m2 had a lower risk of early pump thrombosis but a higher risk of early bleeding compared to children with a BSA of <0.73 m2.
Mortality rates in Berlin Heart-supported patients cannot be predicted by age or BSA. Recovery rates are remarkably high in the smallest patient category (BSA <0.53 m2). This underscores that the BHE is a viable therapeutic option, even for the smallest and youngest patients.
柏林心脏 EXCOR（BHE）为所有儿科年龄段提供循环支持。临床上，不同年龄段的必要护理和结果存在差异。本研究使用 EUROMACS 数据库研究了该特定设备的年龄和大小相关结果。
纳入 2000 年至 2021 年 11 月期间使用 BHE 支持的 EUROMACS 数据库中所有<19 岁的患者。使用最大选择秩统计确定体表面积（BSA）截断值。使用岭惩罚多元 Cox 比例风险回归确定与结果相关的因素。
共纳入 303 例患者[平均年龄：2.0 岁（四分位间距：0.6-8.0，男性：48.5%）]。年龄和 BSA 与死亡率无显著相关性（n=74，P=0.684，P=0.679）。与移植相关的因素（n=175）为年龄（风险比 1.07，P=0.006）和非先天性心脏病病因（风险比 1.46，P=0.020）。BSA<0.53m2 的患者（21.8% vs 1 年时的 4.3-7.6%，P=0.00534）的恢复率最高。BSA≥0.73m2 的患者发生早期泵血栓的风险较低，但早期出血的风险较高，与 BSA<0.73m2 的儿童相比。
不能通过年龄或 BSA 预测柏林心脏支持患者的死亡率。恢复率在最小的患者类别（BSA<0.53m2）中非常高。这强调了 BHE 是一种可行的治疗选择，即使是最小和最年轻的患者。
