Ventricular assist devices (VADs) are widely accepted as therapy to bridge children to heart transplantation. We provide a systematic review of the current state of clinical outcomes in children after paediatric VAD support by the Berlin Heart EXCOR (BH EXCOR) device. A systematic literature search was performed in April 2018. Studies reporting clinical outcomes in at least 15 children supported by a BH EXCOR VAD were included. Additionally, we focused on outcomes in small children and compared outcomes of children supported by a left ventricular assist device (LVAD) versus children supported by a biventricular assist device (BiVAD). Eighteen publications fulfilled the inclusion criteria and were included in this systematic review. Mortality rates ranged from 6.3% [confidence interval (CI) 0.0-18.1%] to 38.9% (2.8-75.0%) while transplantation rates ranged from 37.0% (CI 18.8-55.2%) to 72.5% (CI 63.9-81.2%) and successful weaning rates from 0.0% to 20.7% (CI 6.0-35.5%). In children under 1 year of age, mortality rates ranged from 20.0% to 55.5% and transplantation rates ranged from 0.0% to 62.5%. BiVAD support seemed to result in worse clinical outcomes than LVAD support. Incidence of stroke ranged from 5.0% to 47.0% in all children supported with the BH EXCOR. Although a high incidence of adverse events such as stroke and pump thrombosis is reported, VAD support should be considered in children with end-stage heart failure awaiting heart transplantation. Further research is warranted, especially on optimal timing of device implantation and anticoagulation regimens.

Berlin Heart EXCOR, Mechanical circulatory support, Paediatric, Systematic review, Ventricular assist device,
VSNU Open Access deal
European Journal of Cardio-Thoracic Surgery
received in revised form 21 February 2019; accepted 23 February 2019 - unclear whether covered by VSNU deal as the original submission date is prior to 2019-01-01
Department of Cardio-Thoracic Surgery

Rohde, S, Antonides, C.F.J, Dalinghaus, M, Muslem, R, & Bogers, A.J.J.C. (2019). Clinical outcomes of paediatric patients supported by the Berlin Heart EXCOR: a systematic review. European Journal of Cardio-Thoracic Surgery, 56(5), 830–839. doi:10.1093/ejcts/ezz092