Support Devices Aid heart transplant children and reduce waiting list deaths

Using a support device as a bridge to heart transplantation could reduce the number of children who die while awaiting the procedure, new research indicates

Using a support device as a bridge to heart transplantation could reduce the number of children who die while awaiting the procedure, new research indicates. Support devices are mechanical systems that help ease the burden on the body organ that is damaged-in this case, the heart. The safest type of device seems to be [alink href=”http://www.cincinnatichildrens.org/health/heart-encyclopedia/treat/surg/ecmo.htm”]Extracorporeal Membrane Oxygenation[/alink] (ECMO). With ECMO, the work of the heart and lung is largely performed by a machine that adds oxygen to the blood and then pumps it back into the patient. Such support most likely will not improve the survival of adults awaiting heart transplantation, because there is a shortage of donor organs, according to the report in The Lancet. However, a recent audit showed an excess of donor hearts for kids, so it is possible that such support may offer some benefit to children. To investigate, Dr. Allan P. Goldman, from Great Ormond Street Children’s Hospital in London, and colleagues assessed the outcomes of 22 children with severe heart disease who received mechanical support while waiting for a heart transplant between 1998 and 2002. Seventeen children survived to hospital discharge–a much higher percentage than would have been expected without using a support device, the authors note. The type of support included ECMO in 13 patients and another type called paracorporeal ventricular assistance in 9. Twelve children in the ECMO group survived to discharge, whereas only 5 children in the paracorporeal ventricular assistance group survived to discharge. The waiting time for a heart in the current study group was about 7 days–much shorter than the 18-day period reported for all children who underwent transplantation during the same period. Most of the children in the support group were “urgently listed for the next available compatible donor heart,” the authors note. “Our findings suggest that a national mechanical assist program to bridge children to transplantation can minimize the number dying while on the heart transplant waiting list,” Goldman said in a statement. Although the current findings are encouraging, mechanical support only represents a “lifeboat” for these children, Dr. Mark Boucek, from Children’s Hospital in Denver, comments in a related editorial. “But of course a lifeboat does not guarantee rescue.” “Only a more readily available supply of donor organs can provide the assurance of a rescue procedure for children with acute heart failure,” he emphasizes. (Source: MEDLINE Plus, The Lancet, Dec 2003.)