Congenital Heart Center, Departments of Surgery and Pediatrics, 3463University of Florida, Gainesville, FL, USA.
World J Pediatr Congenit Heart Surg. 2023 Mar;14(2):117-124. doi: 10.1177/21501351221146150. Epub 2023 Feb 16.
We reviewed outcomes in all 36 consecutive children <5 kg supported with the Berlin Heart pulsatile ventricular assist device (VAD) at the University of Florida, comparing those with univentricular circulation (n = 23) to those with biventricular circulation (n = 13).
The primary outcome was mortality. Kaplan-Meier methods and log-rank tests were used to assess group differences in long-term survival after VAD insertion. -tests using estimated survival proportions and standard errors were used to compare groups at specific time points.
Of all 82 patients ever supported with Berlin Heart at our institution, 49 (49/82 = 59.76%) weighed <10 kg and 36 (36/82 = 43.90%) weighed <5 kg. Of these 36 patients who weighed <5 kg, 26 (26/36 = 72.22%) were successfully bridged to transplantation. Of these 36 patients who weighed <5 kg, 13 (13/36 = 36.1%) had biventricular circulation and were supported with 12 biventricular assist devices (BiVADs) and 1 left ventricular assist device (LVAD) (Age [days]: median = 67, range = 17-212; Weight [kilograms]: median = 4.1, range = 3.1-4.9), while 23 (23/36 = 63.9%) had univentricular circulation and were supported with 23 single ventricle-ventricular assist devices (sVADs) (Age [days]: median = 25, range = 4-215; Weight [kilograms]: median = 3.4, range = 2.4-4.9). Of 13 biventricular patients who weighed <5 kg, 12 (12/23 = 92.3%) were successfully bridged to cardiac transplantation. Of 23 functionally univentricular patients who weighed <5 kg, 14 (14/23 = 60.87%) were successfully bridged to cardiac transplantation. For all 36 patients who weighed <5 kg: 1-year survival estimate after VAD insertion = 62.7% (95% confidence interval [CI] = 48.5%-81.2%) and 5-year survival estimate after VAD insertion = 58.5% (95% CI = 43.8%-78.3%). One-year survival after VAD insertion: 84.6% (95% CI = 67.1%-99.9%) in biventricular patients and 49.7% (95% CI = 32.3%-76.4%) in univentricular patients, = 0.018. Three-year survival after VAD insertion: 84.6% (95% CI = 67.1%-99.9%) in biventricular patients and 41.4% (95% CI = 23.6%-72.5%) in univentricular patients, = 0.005.
Pulsatile VAD facilitates bridge to transplantation in neonates and infants weighing <5 kg; however, survival after VAD insertion in these small patients is less in those with univentricular circulation in comparison to those with biventricular circulation.
我们回顾了在佛罗里达大学接受柏林心脏搏动性心室辅助装置（VAD）支持的所有 36 名体重<5kg 的连续患儿的结果，比较了单心室循环（n=23）和双心室循环（n=13）患儿的结果。
主要结果是死亡率。Kaplan-Meier 方法和对数秩检验用于评估 VAD 插入后长期生存的组间差异。使用估计生存比例和标准误差的 t 检验比较特定时间点的组间差异。
在我们机构接受过柏林心脏支持的所有 82 名患者中，49 名（49/82=59.76%）体重<10kg，36 名（36/82=43.90%）体重<5kg。在这 36 名体重<5kg 的患者中，26 名（26/36=72.22%）成功桥接到移植。在这 36 名体重<5kg 的患者中，13 名（13/36=36.1%）有双心室循环，使用 12 个双心室辅助装置（BiVAD）和 1 个左心室辅助装置（LVAD）支持（年龄[天]：中位数=67，范围=17-212；体重[千克]：中位数=4.1，范围=3.1-4.9），而 23 名（23/36=63.9%）有单心室循环，使用 23 个单心室-心室辅助装置（sVAD）支持（年龄[天]：中位数=25，范围=4-215；体重[千克]：中位数=3.4，范围=2.4-4.9）。在 13 名体重<5kg 的双心室患者中，12 名（12/23=92.3%）成功桥接到心脏移植。在 23 名体重<5kg 的功能性单心室患者中，14 名（14/23=60.87%）成功桥接到心脏移植。对于所有 36 名体重<5kg 的患者：VAD 插入后 1 年生存率估计值为 62.7%（95%置信区间[CI]：48.5%-81.2%），VAD 插入后 5 年生存率估计值为 58.5%（95%CI：43.8%-78.3%）。VAD 插入后 1 年生存率：双心室患者为 84.6%（95%CI：67.1%-99.9%），单心室患者为 49.7%（95%CI：32.3%-76.4%），P=0.018。VAD 插入后 3 年生存率：双心室患者为 84.6%（95%CI：67.1%-99.9%），单心室患者为 41.4%（95%CI：23.6%-72.5%），P=0.005。
搏动性 VAD 有助于在<5kg 的新生儿和婴儿中桥接到移植；然而，与双心室循环患者相比，在这些小患者中，VAD 插入后的存活率在单心室循环患者中较低。
