Background:

1. Different clinical courses after Berlin Heart Excor implantation as bridge to heart transplantation in the pediatric age. C. Amarelli, A. Petraio, F. Ursomando, M. Buonocore, I. Fludas, E. Merlino, C. Maiello, G. Caianiello Monaldi Hospital -Azienda Ospedaliera dei Colli - Naples (IT)

2. Different clinical courses after Berlin Heart Excor implantation as bridge to heart transplantation in the pediatric age.. Background: • Pediatric Mechanical Circulatory Support(MCS) is an exciting field; its role is still undefined and results strongly depend from the timing of the implant. • Excor Berlin Heart has been recently approved for pediatric mechanical circulatory support. • Excor Berlin Heart has changed the fate of child awaiting for Heart Transplantation permitting Transplantation and an optimized Donor/Recipient match.

6. BIVAD vs LVAD peculiarity in pediatri age In pediatricpatientstunnelize 4 big cannulas in the thoracicwallopens a large communication and is a source of potentialcolonizations and infections.

7. Different clinical courses after Berlin Heart Excor implantation as bridge to heart transplantation in the pediatric age. Study Aim: To Assess the results of VAD implantation in pediatric ages in a small monocenter Experience with Excor Berlin Heart

8. Different clinical courses after Berlin Heart Excor implantation as bridge to heart transplantation in the pediatric age. Study population • Five children (2-14 years, 3 males) underwent MCS for post-myocarditis heart failure. • Three Biventricular Ventricle Assist Device(BiVAD) were implanted (two after a short course of ECMO support) in the youngest children (2,4 and 9 years-old) • In the two older patients (11 and 14 years-old) hemodynamic data prompt mono-ventricular support (Left Ventricle Assist Device-LVAD) despite a borderline right ventricular dysfunction (TAPSE 12-14 mm)

9. Different clinical courses after Berlin Heart Excor implantation as bridge to heart transplantation in the pediatric age. Results • Four patients (80%) underwent heart transplantation (HT) after a mean time support of 127,25 days (58-242 days) • The fifth patient, supported by BiVADs, deceased soon after VAD implantation for severe pulmonary impairment due to suboptimal pre-operative unloading during peripheral-ECMO support

10. Different clinical courses after Berlin Heart Excor implantation as bridge to heart transplantation in the pediatric age. • Both the BIVAD experiencedsuccessfulchange of the pump for thrombosis. • Both the BIVAD experiencedmixed cannula infection from MSSA and Candida. • One LVAD experienced TIA while INR out of range.

11. Different clinical courses after Berlin Heart Excor implantation as bridge to heart transplantation in the pediatric age. Results • BiVADs patients underwent central-ECMO implantation soon after HT for primary graft failure (one for high donor/recipient weight mismatch and one for anti-HLA Donor Specific Antibodies-DSA) • After a prolonged ECMO support (15 and 28 days) both recovered a good hemodynamic performance and experienced VAC-therapy for fungal mediastinal infection. • The patient with HLA-DSA underwent immune-absorption during ECMO support • LVADs patients had nor post-operative ECMO nor mediastinal infections and the transplant course was uneventful

12. Different clinical courses after Berlin Heart Excor implantation as bridge to heart transplantation in the pediatric age. VAD Berlin Heart Excor implantation is effective both as mono and bi-ventricular MCS in pediatric patients. BIVAD implantation in small children pay an higher incidence of hemodynamic and infective complications before and after HT.

13. Different clinical courses after Berlin Heart Excor implantation as bridge to heart transplantation in the pediatric age. After a careful evaluation of right ventricular function, LVAD implantation may warrant an optimal circulatory support and an uneventful post-transplant course. Future Efforts toward miniaturization of implantable devices also for pediatric population are awaited.