A study published in the current issue of the New England Journal of Medicine (NEJM) has shown that survival using the Excor Pediatric Ventricular Assist Device (VAD) (Berlin Heart) is significantly greater than the standard-of-care (extracorporeal membrane oxygenation, or ECMO) as a bridging therapy for children in need of a heart transplant.
The EXCOR trial is a prospective, multicentre, single-arm cohort study. Children implanted with the Excor Pediatric VAD as a bridge to cardiac transplantation were compared to a historical control group of children supported by ECMO that were selected from the Extracorporeal Life Support Organization registry. Seventeen paediatric cardiac centres in the United States and Canada participated in the trial.
Charles D Fraser, Jr, surgeon-in-chief and head of the Division of Congenital Heart Surgery at Texas Children’s Hospital, and professor of Surgery and Paediatrics at Baylor College of Medicineserved as the national principal investigator for the clinical trial.
A total of 48 patients in need of support (ages 16 and under) were divided into two cohorts based on body size. Each cohort included 24 patients, cohort 1 included the smaller participants and cohort 2, the larger participants. Among participants in cohort 1, median time of support was 27 days in contrast to the matched ECMO control median support time of 5 days. In cohort 2, the median support time was 43 days whereas the ECMO control group was supported a median of 5 days. Overall, 88% of participants in cohort 1 and 92% of participants in cohort 2 survived to either heart transplantation or weaning with the use of the Excor device.
Serious adverse events in cohort 1 and cohort 2 included major bleeding (in 42% and 50% of patients, respectively), infection (in 63% and 50%), and stroke (in 29% and 29%).
“The Excor Pediatric Ventricular Assist Device represents a major medical advance in the treatment of children who need a heart transplant,” said Fraser. “Most of these babies and children would not otherwise survive without the support of Excor while awaiting donor hearts. I know that I speak for all of the medical professionals who participated that we are tremendously gratified to have been a part of this ground-breaking study.”
“Until the FDA approved Excor, options for mechanical circulatory support as a bridge to heart transplantation in children with severe heart failure were finite,” said Robert Kroslowitz, president and CEO of Berlin Heart’s North American operations. “More specifically, the effective period of ECMO support is typically limited to only 10 days before life-threatening complications ensue that often preclude transplantation. The narrow duration of support afforded by ECMO is often inadequate considering current waiting times for a paediatric heart transplant (a median of 119 days for all infants in 2008). Consequently, less than 50% of the children supported on ECMO survive to undergo heart transplantation.”
“Publication of the Excor study results in one of the most esteemed peer-reviewed medical journals in the world offers strong testimony that the FDA’s recent approval of Excor represents a landmark event for children suffering from terminal heart failure,” said Kroslowitz. “Indeed, the worldwide medical community is now offered this lifesaving device to support desperate children who would not otherwise survive while waiting for a heart transplant.”
About the Excor Pediatric VAD
The Excor Pediatric VAD is a mechanical cardiac support system for critically ill paediatric patients suffering from severe heart failure. The system is designed to support paediatric patients of all age groups, from newborns to teenagers, and is intended to bridge patients awaiting heart transplantation from days to many months, until a donor heart becomes available. The FDA granted humanitarian device exemption approval for Excor in December 2011. The device is also approved for use in Europe and Canada.