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A Single Institutional Experience With 36 Children Smaller Than 5 Kilograms Supported With The Berlin Heart Ventricular Assist Device (VAD) Over 12 Years: Comparison Of Patients With Biventricular Versus Functionally Univentricular Circulation
Mark S. Bleiweis, Giles J. Peek, Jeffrey P. Jacobs.
University of Florida, Gainesville, FL, USA.

Objective:
To evaluate outcomes in patients <5kg supported with Berlin Heart VAD, comparing those with univentricular circulation to those with biventricular circulation.
Methods:
We retrospectively reviewed all 36 children <5kg supported with Berlin Heart at our institution. Primary outcome was mortality. Kaplan-Meier methods and log-rank tests were used to assess group differences in long-term survival.
Results:
Of 82 patients ever supported with Berlin Heart at our institution, 49 (49/82=59.76%) weighed <10 kilograms and 36 (36/82=43.90%) weighed <5kg.
26 of these 36 patients who weighed <5kg (26/36=72.22%) were successfully bridged to cardiac transplantation.
23 of these 36 patients who weighed <5kg (23/36=63.88%) were functionally univentricular and received sVAD; 14 of these functionally univentricular patients who weighed <5kg (14/23=60.87%) were successfully bridged to cardiac transplantation.
For all 36 patients who weighed <5kg:1-year survival estimate: 62.7% (95% CI=48.5%-81.2%)5-year estimate: 58.5% (95% CI=43.8%-78.3%)
One-year survival: 84.6% (95% CI=67.1%-99.9%) in biventricular patients and 49.7% (95% CI=32.3%-76.4%) in univentricular patients, P=0.018.
Three-year survival: 84.6% (95% CI=67.1%-99.9%) in biventricular patients and 41.4% (95% CI=23.6%-72.5%) in univentricular patients, P=0.005.
Figure 1 documents longitudinal Kaplan-Meier survival and reveals better survival in biventricular patients (log-rank P=0.02)
Conclusions:
Berlin Heart VAD facilitates bridge to transplantation in children <5kg; however, survival in these small patients is less in those with univentricular circulation in comparison to those with biventricular circulation.


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