Symposium 5
Pediatric mechanical circulatory support in children and patients with congenital heart disease

[ISPHLT-SY5-2] Experiences of EXCOR pediatrics in Japan

^○Hajime Ichikawa¹, Takaya Hoashi¹, Kenta Imai¹, Naoki Okuda¹, Motoki Komori¹, Heima Sakaguchi³, Ken-ichi Kurosaki³, Isao Shiraishi³, Norihide Fukushima² (1.Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Japan, 2.Department of Transplantation, National Cerebral and Cardiovascular Center, Japan, 3.Department of Pediatric Cardiology, National Cerebral and Cardiovasc)

In Japan, the number of pediatric heart transplantation is far less than it is needed, because of the donor shortage. For the infant with profound heart failure, the only way to safely survive to be transplanted is to have Berlin Heart EXCOR. EXCOR was approved by Japanese government in Japan in 2015. The number of hospitals has been gradually increased to 12 with 44 IKUS. To date, 84 patients underwent circulatory support with EXCOR. The median age and the body weight at EXCOR implantation, were 461.5 days old and 7.1 kg, respectively. ECMO support was performed before the implantation of EXCOR in 29 patients. Although the number is limited, the outcome seems excellent. Thirty two patients (17 domestic and 15 abroad) underwent heart transplantation 366.2 days (mean) after the EXCOR was implanted. Weaning from EXCOR was achieved in 17 patients. Conversion to other mechanical assist device was done in 6 patients. Morbidity was observed in 4 patients. Currently, 25 patients are on EXCOR support. Unfortunately, because the number of IKUS is limited, it is impossible to implant EXCOR if a new patient needs one at this moment (2021/5/17). Adverse event includes membrane fracture in 27 pumps, thrombus formation which necessitate pump exchange in 54 pumps. Broken cannulae were seen in 3. Among the adverse events with EXCOR, drive line infection is the most annoying problem in the long term support. No matter how the skin cannula site is initially placed in an ideal position, as the patient is recovering they move actively. Then the cannula exit site was damaged and contaminated with bacteria. Even without bacteria, the skin is somewhat damaged by the movement. There is also a problem related to the somatic growth of the patient. Since the support period is extremely long compared with the patients in North America or Europe, displacement of the cannula from left ventricle, broken aortic cannula or pseudoaneurysm formation at the aortic cannula were seen in Japan. In this paper, the problems in the long term support with EXCOR and our strategy to manage this situation will be presented