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. 2022 Jun 15;35(1):ivac051.
doi: 10.1093/icvts/ivac051.

Short-term outcomes of EXCOR Paediatric implantation

Motoki Komori  1 , Takaya Hoashi  1 , Heima Sakaguchi  2 , Kenta Imai  1 , Naoki Okuda  1 , Norihide Fukushima  3 , Kenichi Kurosaki  2 , Hajime Ichikawa  1
Affiliations

Short-term outcomes of EXCOR Paediatric implantation

Motoki Komori et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: The aim of this study was to review a single institution's experience with EXCOR Paediatric implantation.

Methods: Patients <15 years old who underwent EXCOR implantation as a bridge to transplantation between 2015 and 2021 were enrolled. Major adverse events included death, cerebrovascular event resulting in sequelae, major infection (sepsis or surgical site infection requiring open sternal irrigation or device removal) and device malfunction requiring surgical treatment.

Results: Overall median age and weight for all 20 children at implantation were 10.8 (interquartile range, 7.9-33.2) months and 6.3 (4.6-10.2) kg. Ten patients (50%) weighed <5 kg. Primary diagnoses were dilated cardiomyopathy in 13 patients, fulminant myocarditis in 3, restrictive cardiomyopathy in 2 and congenital heart disease in 2. Two patients required biventricular assist support. The median support time was 365 (241-636) days. Six patients (30%) were supported for >20 months. One patient died. Seven patients underwent heart transplant. Heart transplant has not been performed in the last 1.5 years. Five patients were weaned from EXCOR support after native myocardial recovery, including a patient with dilated cardiomyopathy who recovered after 24 months of EXCOR support. Major complication-free survival at 6, 12 and 18 months were 79.3%, 49.6% and 38.6%, respectively. Body weight <5 kg at implantation was a risk factor for decreased major complication-free survival.

Conclusions: Survival during EXCOR Paediatric support was good, but it prolonged the wait time for a heart transplant. The number of major complications increased over time and was not negligible, especially in small children.

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Figures

Figure 1:
Figure 1:
Competing outcomes (death, heart transplant, recovery, or ongoing support) in patients undergoing EXCOR Paediatric implantation.
Figure 2:
Figure 2:
Photomicrographs (×500, scale bar = 50 μm) of Masson’s trichrome staining at the mid-mural layer of the left ventricular wall at (A) EXCOR implantation and (B) removal 24 months later.
Figure 3:
Figure 3:
Major complication-free survival (A) and results by body weight (B).
Figure 4:
Figure 4:
Representative macro findings of (A) exit site infection and (B) gallium scintigraphy of outflow cannula infection.
Figure 5:
Figure 5:
Inflow cannula detachment was confirmed by (A) sagittal and (B) coronal views of contrast-enhanced computed tomography. (C) Increase in height of patients who received EXCOR ventricular assist device support for over 12 months (n = 11). The dotted line represents a patient who developed inflow cannula detachment.
None
See this image and copyright information in PMC

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