Images in Cardiovascular Medicine
Successful Orthotopic Heart Transplantation After the Longest Duration of EXCOR® Pediatric Support in the World
2025 Volume 89 Issue 1 Pages 145-
Details
2025 Volume 89 Issue 1 Pages 145-
In Japan, the only durable left ventricular assist device (LVADs) for use as a bridge-to-heart transplantation for children weighing <20 kg with endstage heart failure is the EXCOR® Pediatric (Berlin Heart, Berlin, Germany). However, the rapid somatic growth of small children requires appropriate increases in LVAD output.1
A 2-month-old girl with left ventricular noncompaction underwent LVAD implantation (EXCOR® Pediatric) when her body weight was 4.0 kg (Figure A). During the 1,851 days of mechanical circulatory support until successful orthotopic heart transplantation at the age of 5 years, when her body weight was 17 kg (Figure B), the pump size-was increased from 10 cc to 15 cc to 25 cc and the cannula size-from 6 mm to 9 mm in diameter. Because of a daily schedule of disinfection of the cannulae exit sites using benzalkonium chloride, and twice weekly monitoring of the prothrombin time-international normalized ratio to within 2.5–3.5, she was free from exit site infections and cerebrovascular events during the entire LVAD support period. In addition, securing the EXCOR pump using a custom-made pocket and belt (Figure A,B), together with round-the-clock caregiver support, played a crucial role in her survival. Antibody-mediated rejection occurred after the transplantation, but was treated by steroid pulse therapy and high-dose immunoglobulin therapy. She was discharged 3 months after transplantation.
The patient as an infant (A) and at 5 years old (B). White arrow indicates the custom-made pocket and belt to secure the EXCOR® pump. Black arrow indicates the console of the EXCOR, Ikus®.
None declared.
The present study was approved by Saitama Medical University International Medical Center Institutional Review Boad. Reference number: 2023-146.
