Long-term Paracorporeal Pulsatile Mechanical Circulatory Support in Adolescent and Adult Patients.

OBJECTIVES: Our study objective was to analyse adverse events in adolescent and adult Berlin Heart EXCOR patients and to assess outcome of subsequent heart transplantation (HTX).

METHODS: From 2006 to 2020, 58 patients (12-64 years) received a biventricular assist device (BIVAD) at our institution and were included in this study.

RESULTS: Causes of biventricular heart failure were non-ischaemic cardiomyopathy (62.1%), ischaemic cardiomyopathy (22.4%) and myocarditis (15.5%). Median INTERMACS score was I (I-III). Median age was 49 years (IQR 34-55 years) and 82.8% were male. Causes of death were: multi-organ failure (25.0%), septic shock (17.9%), cerebral haemorrhage (14.3%), bleeding (14.3%) and embolic events (14.3%). Major bleedings were more frequent in the group who died on BIVAD (60.7 vs 6.7%, p < 0.001). Wound infections were more prevalent in HTX recipients (n = 21, 70.0%). After BIVAD thrombosis, 104 chamber exchanges were performed in 28 patients (48.3%). HTX was performed in 52.6% of the patients after BIVAD support time 316 ± 240 days. Mean time to follow-up of 30 HTX recipients was 1722 ± 1368 days. One-, 6- and 12-month-survival after heart transplantation were 96.7%, 90.0% and 76.7% respectively. Long-term survival after 5 and 10 years was 69.7%.

CONCLUSIONS: Pump thrombosis, infections and bleeding after BIVAD did not preclude successful HTX. Although only 50% of BIVAD patients were successfully transplanted, long-term survival after HTX in BIVAD patients was non-inferior when compared to other recipients.