Ventricular assist device in children with terminal heart failure caused by dilatative cardiomyopathy

In children with dilated cardiomyopathy the disease may progress so rapidly that they die during the waiting period before a suitable donor organ is f ound. Fifteen children of 4 months to 15 years of age had been in congestive hear t failure with multiorgan failure due to dilated cardiomyopathy, where inte nsive medical treatment had failed. After resuscitation, a miniaturized pul satile ventricular assist device for the mechanical replacement of heart fu nction was implanted. The biventricular assist device ("Berlin Heart") cons ists of two extracorporeal pneumatically driven polyurethane blood pumps, w ith a multi-layer flexible membrane that separates a blood and an air chamb er. Four silicon cannulae connect the blood pumps to the patient. A three-l eaflet valve prevents blood reflux. The pumps are driven by a pulsatile ele ctropneumatic system. In 12 of the 15 children the bridging to transplantation was successful wit h a support time of 1 to 98 days (mean 24 days). Nine of them were extubate d and mobilized while assisted. Three children died during the support time due to hemorrhage, sepsis, and pulmonary failure. In addition, there was o ne infarction of the arteria cerebri media. To date seven of the transplant ed children are in good condition on follow-up. The beneficial effects of ventricular assist device use are well known in a dult patients and with special devices it can be transfered to infants and children in whom longer need for support is anticipated. Even in small infa nts it is an effective method for bridging to cardiac transplantation.