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Surgical strategies for the management of end‐stage heart failure in infants and children: A 15‐year experience with a patient‐tailored approach
End‐stage heart failure (ESHF) in pediatric age is an ongoing challenge. Heart transplantation is the final option, but its long‐term outcomes are still suboptimal in children. An alternative patient‐tailored surgical protocol to manage ESHF in children is described. Retrospective, single‐center ana...
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| Published in: | Artificial organs 2021-12, Vol.45 (12), p.1543-1553 |
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| creator | Ponzoni, Matteo Frigo, Anna C. Castaldi, Biagio Cerutti, Alessia Di Salvo, Giovanni Vida, Vladimiro L. Padalino, Massimo A. |
| description | End‐stage heart failure (ESHF) in pediatric age is an ongoing challenge. Heart transplantation is the final option, but its long‐term outcomes are still suboptimal in children. An alternative patient‐tailored surgical protocol to manage ESHF in children is described. Retrospective, single‐center analysis of pediatric patients admitted to our institution between April 2004 and February 2021 for ESHF. Our current protocol is as follows: (a) Patients |
| doi_str_mv | 10.1111/aor.14057 |
| format | article |
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An integrated and patient‐tailored surgical protocol for end‐stage heart failure in children, comprehensive of pulmonary artery banding for left ventricular rehabilitation and long‐term mechanical circulatory support devices, can provide very good early and medium‐term survival.</description><identifier>ISSN: 0160-564X</identifier><identifier>EISSN: 1525-1594</identifier><identifier>DOI: 10.1111/aor.14057</identifier><identifier>PMID: 34461675</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adverse events ; Cardiomyopathy ; Cardiomyopathy, Dilated - surgery ; Child ; Child, Preschool ; Children ; Congestive heart failure ; Dilated cardiomyopathy ; Female ; Heart Defects, Congenital - surgery ; Heart failure ; Heart Failure - surgery ; Heart transplantation ; Heart Transplantation - statistics & numerical data ; Heart-Assist Devices ; Humans ; Infant ; Infants ; Main Text ; Male ; mechanical circulatory support ; Patients ; pediatric heart failure ; Pediatrics ; Postoperative Complications ; Pulmonary arteries ; Pulmonary artery ; Pulmonary Artery - surgery ; pulmonary artery banding ; Recovery ; Retrospective Studies ; Survival ; Survival Analysis ; Transplantation ; Transplants & implants ; Treatment Outcome ; Ventricle ; Ventricular assist devices ; Ventricular Dysfunction, Left - surgery ; ventricular rehabilitation ; Vigilance</subject><ispartof>Artificial organs, 2021-12, Vol.45 (12), p.1543-1553</ispartof><rights>2021 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.</rights><rights>2021. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4437-b615699b332e2b7c89c3eac32fb049a1f74ab2fb44231a30f350363b77338ddd3</citedby><cites>FETCH-LOGICAL-c4437-b615699b332e2b7c89c3eac32fb049a1f74ab2fb44231a30f350363b77338ddd3</cites><orcidid>0000-0003-4472-6287 ; 0000-0002-0343-8118</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34461675$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ponzoni, Matteo</creatorcontrib><creatorcontrib>Frigo, Anna C.</creatorcontrib><creatorcontrib>Castaldi, Biagio</creatorcontrib><creatorcontrib>Cerutti, Alessia</creatorcontrib><creatorcontrib>Di Salvo, Giovanni</creatorcontrib><creatorcontrib>Vida, Vladimiro L.</creatorcontrib><creatorcontrib>Padalino, Massimo A.</creatorcontrib><title>Surgical strategies for the management of end‐stage heart failure in infants and children: A 15‐year experience with a patient‐tailored approach</title><title>Artificial organs</title><addtitle>Artif Organs</addtitle><description>End‐stage heart failure (ESHF) in pediatric age is an ongoing challenge. Heart transplantation is the final option, but its long‐term outcomes are still suboptimal in children. An alternative patient‐tailored surgical protocol to manage ESHF in children is described. Retrospective, single‐center analysis of pediatric patients admitted to our institution between April 2004 and February 2021 for ESHF. Our current protocol is as follows: (a) Patients <1 year with isolated left ventricular dysfunction due to dilated cardiomyopathy underwent pulmonary artery banding (PAB). (b) Patients <10 years and <20 kg, who did not meet previous criteria were managed with Berlin Heart EXCOR. (c) Patients >10 years or >20 kg, underwent placement of intracorporeal Heartware. Primary outcomes were survival, transplant incidence, and postoperative adverse events. A total of 24 patients (mean age 5.3 ± 5.9 years) underwent 26 procedures: PAB in 6 patients, Berlin Heart in 11, and Heartware in 7. Two patients shifted from PAB to Berlin Heart. Overall survival at 1‐year follow‐up and 5‐year follow‐up was 78.7% (95%CI = 62%‐95.4%) and 74.1% (95%CI = 56.1%‐92.1%), respectively. Berlin Heart was adopted in higher‐risk settings showing inferior outcomes, whereas a PAB enabled 67% of patients to avoid transplantation, with no mortality. An integrated, patient‐tailored surgical strategy, comprehensive of PAB and different types of ventricular assist devices, can provide satisfactory medium‐term results for bridging to transplant or recovery. The early postoperative period is critical and requires strict clinical vigilance. Selected infants can benefit from PAB that has demonstrated to be a safe bridge to recovery.
An integrated and patient‐tailored surgical protocol for end‐stage heart failure in children, comprehensive of pulmonary artery banding for left ventricular rehabilitation and long‐term mechanical circulatory support devices, can provide very good early and medium‐term survival.</description><subject>Adverse events</subject><subject>Cardiomyopathy</subject><subject>Cardiomyopathy, Dilated - surgery</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Congestive heart failure</subject><subject>Dilated cardiomyopathy</subject><subject>Female</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Heart failure</subject><subject>Heart Failure - surgery</subject><subject>Heart transplantation</subject><subject>Heart Transplantation - statistics & numerical data</subject><subject>Heart-Assist Devices</subject><subject>Humans</subject><subject>Infant</subject><subject>Infants</subject><subject>Main Text</subject><subject>Male</subject><subject>mechanical circulatory support</subject><subject>Patients</subject><subject>pediatric heart failure</subject><subject>Pediatrics</subject><subject>Postoperative Complications</subject><subject>Pulmonary arteries</subject><subject>Pulmonary artery</subject><subject>Pulmonary Artery - surgery</subject><subject>pulmonary artery banding</subject><subject>Recovery</subject><subject>Retrospective Studies</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><subject>Ventricle</subject><subject>Ventricular assist devices</subject><subject>Ventricular Dysfunction, Left - surgery</subject><subject>ventricular rehabilitation</subject><subject>Vigilance</subject><issn>0160-564X</issn><issn>1525-1594</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp1kc1qFTEUxwdR7G114QtIwI1dTJtMPmbGReFS_IJCwQ9wF85kztxJmZuMScZ6dz6CKx_QJzF6a1HBEAgn-Z0fJ_yL4hGjJyyvU_DhhAkq6zvFislKlky24m6xokzRUirx4aA4jPGKUloLqu4XB1wIxVQtV8W3t0vYWAMTiSlAwo3FSAYfSBqRbMHBBrfoEvEDQdd___I1pnxFRoSQyAB2WgIS6_IewKVIwPXEjHbqA7pnZE2YzD27TBP8PGOw6AySa5tGAmSGlOuUgZRFPmBPYJ6DBzM-KO4NMEV8eHMeFe9fPH93_qq8uHz5-nx9URoheF12iknVth3nFVZdbZrWcATDq6GjogU21AK6XAhRcQacDlxSrnhX15w3fd_zo-Js752Xbou9yeMEmPQc7BbCTnuw-u8XZ0e98Z90W7WValQWPL0RBP9xwZj01kaD0wQO_RJ1JVXdNkzKJqNP_kGv_BJc_l6mWtXIpqp4po73lAk-xoDD7TCM6p9p65y2_pV2Zh__Of0t-TveDJzugWs74e7_Jr2-fLNX_gDwNblR</recordid><startdate>202112</startdate><enddate>202112</enddate><creator>Ponzoni, Matteo</creator><creator>Frigo, Anna C.</creator><creator>Castaldi, Biagio</creator><creator>Cerutti, Alessia</creator><creator>Di Salvo, Giovanni</creator><creator>Vida, Vladimiro L.</creator><creator>Padalino, Massimo A.</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4472-6287</orcidid><orcidid>https://orcid.org/0000-0002-0343-8118</orcidid></search><sort><creationdate>202112</creationdate><title>Surgical strategies for the management of end‐stage heart failure in infants and children: A 15‐year experience with a patient‐tailored approach</title><author>Ponzoni, Matteo ; Frigo, Anna C. ; Castaldi, Biagio ; Cerutti, Alessia ; Di Salvo, Giovanni ; Vida, Vladimiro L. ; Padalino, Massimo A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4437-b615699b332e2b7c89c3eac32fb049a1f74ab2fb44231a30f350363b77338ddd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adverse events</topic><topic>Cardiomyopathy</topic><topic>Cardiomyopathy, Dilated - surgery</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Congestive heart failure</topic><topic>Dilated cardiomyopathy</topic><topic>Female</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Heart failure</topic><topic>Heart Failure - surgery</topic><topic>Heart transplantation</topic><topic>Heart Transplantation - statistics & numerical data</topic><topic>Heart-Assist Devices</topic><topic>Humans</topic><topic>Infant</topic><topic>Infants</topic><topic>Main Text</topic><topic>Male</topic><topic>mechanical circulatory support</topic><topic>Patients</topic><topic>pediatric heart failure</topic><topic>Pediatrics</topic><topic>Postoperative Complications</topic><topic>Pulmonary arteries</topic><topic>Pulmonary artery</topic><topic>Pulmonary Artery - surgery</topic><topic>pulmonary artery banding</topic><topic>Recovery</topic><topic>Retrospective Studies</topic><topic>Survival</topic><topic>Survival Analysis</topic><topic>Transplantation</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><topic>Ventricle</topic><topic>Ventricular assist devices</topic><topic>Ventricular Dysfunction, Left - surgery</topic><topic>ventricular rehabilitation</topic><topic>Vigilance</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ponzoni, Matteo</creatorcontrib><creatorcontrib>Frigo, Anna C.</creatorcontrib><creatorcontrib>Castaldi, Biagio</creatorcontrib><creatorcontrib>Cerutti, Alessia</creatorcontrib><creatorcontrib>Di Salvo, Giovanni</creatorcontrib><creatorcontrib>Vida, Vladimiro L.</creatorcontrib><creatorcontrib>Padalino, Massimo A.</creatorcontrib><collection>Open Access: Wiley-Blackwell Open Access Journals</collection><collection>Wiley Online Library Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Artificial organs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ponzoni, Matteo</au><au>Frigo, Anna C.</au><au>Castaldi, Biagio</au><au>Cerutti, Alessia</au><au>Di Salvo, Giovanni</au><au>Vida, Vladimiro L.</au><au>Padalino, Massimo A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical strategies for the management of end‐stage heart failure in infants and children: A 15‐year experience with a patient‐tailored approach</atitle><jtitle>Artificial organs</jtitle><addtitle>Artif Organs</addtitle><date>2021-12</date><risdate>2021</risdate><volume>45</volume><issue>12</issue><spage>1543</spage><epage>1553</epage><pages>1543-1553</pages><issn>0160-564X</issn><eissn>1525-1594</eissn><abstract>End‐stage heart failure (ESHF) in pediatric age is an ongoing challenge. Heart transplantation is the final option, but its long‐term outcomes are still suboptimal in children. An alternative patient‐tailored surgical protocol to manage ESHF in children is described. Retrospective, single‐center analysis of pediatric patients admitted to our institution between April 2004 and February 2021 for ESHF. Our current protocol is as follows: (a) Patients <1 year with isolated left ventricular dysfunction due to dilated cardiomyopathy underwent pulmonary artery banding (PAB). (b) Patients <10 years and <20 kg, who did not meet previous criteria were managed with Berlin Heart EXCOR. (c) Patients >10 years or >20 kg, underwent placement of intracorporeal Heartware. Primary outcomes were survival, transplant incidence, and postoperative adverse events. A total of 24 patients (mean age 5.3 ± 5.9 years) underwent 26 procedures: PAB in 6 patients, Berlin Heart in 11, and Heartware in 7. Two patients shifted from PAB to Berlin Heart. Overall survival at 1‐year follow‐up and 5‐year follow‐up was 78.7% (95%CI = 62%‐95.4%) and 74.1% (95%CI = 56.1%‐92.1%), respectively. Berlin Heart was adopted in higher‐risk settings showing inferior outcomes, whereas a PAB enabled 67% of patients to avoid transplantation, with no mortality. An integrated, patient‐tailored surgical strategy, comprehensive of PAB and different types of ventricular assist devices, can provide satisfactory medium‐term results for bridging to transplant or recovery. The early postoperative period is critical and requires strict clinical vigilance. Selected infants can benefit from PAB that has demonstrated to be a safe bridge to recovery.
An integrated and patient‐tailored surgical protocol for end‐stage heart failure in children, comprehensive of pulmonary artery banding for left ventricular rehabilitation and long‐term mechanical circulatory support devices, can provide very good early and medium‐term survival.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34461675</pmid><doi>10.1111/aor.14057</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-4472-6287</orcidid><orcidid>https://orcid.org/0000-0002-0343-8118</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adverse events Cardiomyopathy Cardiomyopathy, Dilated - surgery Child Child, Preschool Children Congestive heart failure Dilated cardiomyopathy Female Heart Defects, Congenital - surgery Heart failure Heart Failure - surgery Heart transplantation Heart Transplantation - statistics & numerical data Heart-Assist Devices Humans Infant Infants Main Text Male mechanical circulatory support Patients pediatric heart failure Pediatrics Postoperative Complications Pulmonary arteries Pulmonary artery Pulmonary Artery - surgery pulmonary artery banding Recovery Retrospective Studies Survival Survival Analysis Transplantation Transplants & implants Treatment Outcome Ventricle Ventricular assist devices Ventricular Dysfunction, Left - surgery ventricular rehabilitation Vigilance |
| title | Surgical strategies for the management of end‐stage heart failure in infants and children: A 15‐year experience with a patient‐tailored approach |
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