100 Episodes of Support With Berlin Heart: Comparison of Patients Who Underwent Ventricular Assist Device Explantation After Cardiac Recovery With Those Without Cardiac Recovery.

Abstract

We report our first 100 episodes of patient support with a pulsatile paracorporeal ventricular assist device (VAD) (Berlin Heart). Characteristics and outcomes of those patients who underwent VAD explantation after native ventricular recovery (n = 7) are compared with those of patients without ventricular recovery supported as a bridge to transplantation (n = 92 who underwent 93 episodes of VAD support). Comparisons between the 2 cohorts were made using descriptive statistics: count (n), median and interquartile range (IQR; Q1-Q3), and range (range). Of 93 episodes of VAD support without native ventricular recovery, acquired heart disease (myocarditis/cardiomyopathy) occurred in 39 (41.9%), VAD support after cardiac transplantation was 2 (2.2%), congenital heart disease was 52 (55.9%), and functionally univentricular circulation was 40 (43.0%). Of 7 patients who underwent VAD weaning and subsequent VAD explantation after cardiac recovery, acquired heart disease (myocarditis/cardiomyopathy) was present in 6 (85.7%) and congenital heart disease was present in 1 (14.3%). Biventricular circulation was present in 7 of 7 (100%). None of these 7 patients (0%) presented with renal dysfunction or hepatic dysfunction before VAD insertion. In these 7 explanted patients, age at VAD insertion was 107 days (IQR, 31-236 days; range, 29-449 days), weight at VAD insertion was 6 kg (IQR, 3.8-6.3 kg; range, 2.63-7.08 kg), age at VAD removal was 261 days (IQR, 83-451 days; range, 167-557 days), and length of VAD support was 138 days (IQR, 102-164 days; range, 76-215 days). Follow-up was 4.4 years (IQR, 1.8-6.8 years; range, 1.5-7.3 years). Overall survival to date is 7 of 7 (100%). Of 7 patients who underwent VAD removal, 6 still have their native hearts, and 1 underwent subsequent cardiac transplantation 334 days after VAD removal. Berlin Heart is an effective bridge to transplantation; however, a subset of patients supported with Berlin Heart (with biventricular circulation and myocarditis and/or cardiomyopathy) may experience myocardial recovery and become candidates for VAD decannulation.