1. Singh Joy, Subhashni D.


According to this study:


* A new ventricular assist device designed for use in children with heart failure resulted in significantly higher survival than did extracorporeal membrane oxygenation during the bridge to transplantation.


* Serious adverse events, such as bleeding, injection, and stroke, were common in all participants.



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Historically, children with heart failure have been given extracorporeal membrane oxygenation (ECMO) for circulatory support while awaiting transplantation. However, ECMO use is restricted typically to 10 to 20 days because of serious complications, and the mortality rate with ECMO use is high. A recent study compared ECMO with a new ventricular assist device that can be implanted in children.


In this prospective study, children ages 16 years and younger were eligible if they met weight requirements, had two-ventricle circulation, and had severe heart failure and were awaiting transplantation.


The 48 participants who received the new ventricular device were divided into two cohorts according to body size: cohort 1 comprised 24 patients with a median age of one year and median weight of 9 kg; the 24 patients in cohort 2 had a median age of nine years and a median weight of 31 kg. These 48 patients were matched to a historical group of children who had received ECMO.


The primary end point in the ECMO group was the time to death; the primary end point in the comparison group was the time to death or an unacceptable neurologic outcome after weaning from the device.


Children with the new ventricular device received support for a median of 28 days in cohort 1 and for 43 days in cohort 2, compared with five days in both matched ECMO groups. In cohort 1 the median time to death or unacceptable neurologic outcome hadn't been reached at 174 days. In comparison, the median time to death in the age-matched ECMO group was 13 days. In cohort 2 the primary end point arrived at a median of 144 days, compared with 10 days in the age-matched ECMO group. A total of 92% of patients in cohort 2 and 88% in cohort 1 underwent successful transplantation or weaning from the device.


Although serious adverse events, such as bleeding, infection, and stroke, were common among participants, survival among the children receiving circulatory support from the new ventricular assist device was significantly higher than that among the children in the ECMO groups.




Fraser CD, et al. N Engl J Med. 2012;367(6):532-41