In a recent study in The New England Journal of Medicine researchers from across North America, including The Hospital for Sick Children (SickKids), evaluated the safety and effectiveness of a ventricular assist device called the Berlin Heart as a bridge therapy for children who were on waiting lists for heart transplants. They found that survival rates were significantly higher with the ventricular assist device compared to the traditional therapy, known as extracorporeal membrane oxygenation or ECMO.
A ventricular assist device is a pump that supports the heart and blood flow in people with weakened hearts. It is used to bridge the gap between the time a patient needs a heart transplant and the time a donor heart becomes available. In 2004, SickKids became one of the first institutions in North America to use the Berlin Heart and since then this device has supported more than two dozen children at SickKids as they wait for transplantation.
“The results of this study strengthen previous single centre reports of positive experiences with the Berlin Heart device and marks a new era for children with severe heart failure waiting for a new heart,” says Dr. Tilman Humpl, a researcher on this study and Staff Physician in the Critical Care Unit at SickKids.
The most common therapy for children in need of circulatory support has been ECMO and while it gives the body time to rest, it can cause serious complications and is typically used for only 10 to 20 days. This is not adequate considering some children wait an average of 119 days before an organ becomes available.
The Berlin Heart allows patients to be cared for in hospital, outside of the ICU and also allows them to be mobile rather than restricted to the hospital bed. The study showed that by 174 days, 88 per cent of the Berlin Heart patients in cohort one had undergone successful transplantation or been weaned from the device. By 192 days, 92 per cent of patients in a second study group had done the same.
As with the use of any ventricular assist device for circulatory support in adults and children, serious adverse events such as bleeding, infection and stroke, occurred in the majority of study participants. Tilman explains that these adverse events don’t typically prevent a child from getting a transplant.
The Hospital for Sick Children (SickKids)