American Society of Hirudotherapy

Improving Mechanical Circulatory Support Outcomes in Failing Bidirectional Glenn Physiology

Retrospective analysis published in Pediatric Cardiology (2024)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Research reportClinical LiteratureDrug DevelopmentKobayashi RL et al. · Pediatric Cardiology, 2025

Abstract

There remains high morbidity and mortality with mechanical circulatory support (MCS) in failing bidirectional Glenn (BDG) physiology. We performed a retrospective analysis of children with BDG physiology supported with MCS before and after 2018. Fourteen patients met inclusion criteria (median age 1.5 years, weight 9 kg). Prior to 2018 (n = 7), with variable anticoagulation and strategies including pulsatile VAD, continuous flow VAD, and extracorporeal membrane oxygenation (ECMO), 3 (43%) of patients were transplanted with a total of 536 patient-days of support (median 59 days). Major hemocompatability-related adverse event (MHRAE) rate was 63 per 100 patient-months. After 2018 (n = 7), using a staged support strategy (ECMO to pulsatile VAD) and bivalirudin anticoagulation, 5 (71%) patients were transplanted with a total of 1260 patient-days of support (median 188 days) and MHRAE rate of 24 per 100 patient-months. Despite challenging physiology, we have observed improved survival and reduced MHRAE despite longer support duration.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal Article
Indexed MeSH termsHumansRetrospective StudiesInfantExtracorporeal Membrane OxygenationHeart-Assist DevicesMaleFemaleChild, PreschoolFontan ProcedureChildHeart TransplantationHeart Defects, CongenitalTreatment OutcomeAnticoagulantsPeptide FragmentsHirudinsRecombinant Proteins

Summary

Children with failing bidirectional Glenn physiology on MCS; the post-2018 strategy combining staged ECMO-to-pulsatile-VAD support with bivalirudin anticoagulation reduced major hemocompatibility adverse events from 63 to 24 per 100 patient-months despite longer support duration.

Why This Matters for Hirudotherapy

This retrospective analysis examined outcomes in 14 children with failing bidirectional Glenn physiology who required mechanical circulatory support, comparing strategies before and after 2018. After 2018, a staged support strategy using bivalirudin anticoagulation was associated with improved survival, longer support duration, and reduced hemocompatibility-related adverse events. The abstract does not mention hirudin, leeches, hirudotherapy, or any connection to the leech secretome. Bivalirudin (formerly Hirulog) is a synthetic peptide anticoagulant designed partly on the C-terminal sequence of hirudin, the anticoagulant of the medicinal leech (Maraganore et al., 1990); this paper studies the drug, not leech therapy.

Citation

Reference (Vancouver style)

Kobayashi RL, Williams RJ, Gauvreau K, Daly KP, Esteso P, Milligan C, et al. Improving Mechanical Circulatory Support Outcomes in Failing Bidirectional Glenn Physiology. Pediatr Cardiol. 2025;46(6):1719-1724. doi:10.1007/s00246-024-03597-4. PMID: 39030349

Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.

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