Options for mechanical circulatory support as a bridge to transplantation are limited for children. The mainstay of support for small children has been extracorporeal membrane oxygenation (ECMO). The effective period of support with ECMO is typically limited to only 10 to 20 days before serious complications ensue, such as bleeding and major organ-system failure, which often preclude transplantation. The short duration of support afforded by ECMO is often inadequate, considering the current waiting times (a median of 119 days for all infants in 20085). As a result, only 40 to 60% of children requiring support with ECMO survive long enough to undergo heart transplantation.9
The Excor Pediatric ventricular assist device (Berlin Heart) is a paracorporeal, pneumatically driven, pulsatile-flow mechanical circulatory-support device available in a wide range of sizes. We conducted a prospective study to evaluate this device as bridge therapy in children who were on waiting lists for orthotopic heart transplantation.