Improved outcomes with pulsatile paracorporeal ventricular assist device support in children: A single-center experience

OBJECTIVE: The Berlin Heart EXCOR (BHE) remains the only long-term mechanical circulatory support option for small children, yet it carries a high risk of morbidity and mortality, most notably from cerebrovascular accidents (CVAs). This study evaluates how the outcomes of children supported with BHE changed with evolving management. METHODS: All consecutive patients receiving BHE at our institution from 2009 to 2024 were included. RESULTS: BHE support was used in 75 patients (median age 1 year). Median support duration was 128 days. Transplantation was achieved in 64% (48/75) of patients. BHE was removed because of recovery in 13.3% (10/75), and 21.3% (16/75) died while on BHE support. Overall survival was 87.7%, 80.9%, and 65.9% at 1, 6, and 12 months, respectively. Survival improved significantly after 2019 (hazard ratio, 0.14; 95% confidence interval, 0.03-0.72; P = .02), whereas the risk of death was greater in patients with CVA (hazard ratio, 3.08; 95% confidence interval, 0.99-9.47; P = .05). A total of 36 CVAs occurred in 23 patients (31%). Freedom from CVA at 1, 6, and 9 months was 81.8%, 67.5%, and 59.1%, respectively. Overall CVA incidence and freedom from CVA did not differ between eras, but fatal CVA incidence decreased (54% vs 10%, P = .03), coinciding with increased rate of successful outcomes (transplantation and explantation: 70.8% vs 92.6%, P = .03). Key differences between eras included the introduction of bivalirudin, decreased threshold for cannula/pump interventions (1.4 vs 5.8 per patient, P < .001), and more proactive timing of support, with fewer patients progressing to preimplantation cardiogenic shock (P = .02) and reduced pre-BHE extracorporeal membrane oxygenation (P = .04) and pre-BHE centrifugal pump support (P = .007). CONCLUSIONS: Modern BHE management significantly reduces incidence of fatal strokes and improves survival, despite increased duration of support.

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

Cohort of 75 children supported with Berlin Heart EXCOR; introduction of bivalirudin anticoagulation post-2019 correlated with reduced fatal stroke incidence (54% → 10%) and improved transplant/explantation outcomes (70.8% → 92.6%).

Leech-derived molecules this paper discusses, each with a full profile in the ASH compound registry:

Explore cómo esta investigación se conecta con la práctica clínica

More peer-reviewed studies in Ensayos clínicos.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• Efficacy and Safety of Hirudotherapy for Improving Sperm Quality Parameters in Male Infertility: A Randomized Controlled Trial — Abtahi-Forooshani M et al. (2026)
• Reverse Sural Flap Venous Congestion Successfully Managed With Enoxaparin in a Male Patient With a Traumatic Foot Crush Injury: A Case Report — Velasco-Bustamante J et al. (2026)
• Investigation of the therapeutic effects of medicinal leech treatment on lower extremity ischemia-reperfusion injury — Ünal K et al. (2026)
• Efficacy of Medicinal Leech Therapy in Diverse Clinical Applications: A Comprehensive Study from Azerbaijan — Farzali S et al. (2025)
• HIRUDOTHERAPY IN RECONSTRUCTIVE SURGERY: CASE-REPORTS AND REVIEW — Heinz P et al. (2020)
• Hirudotherapy Efficacy and Complications in the Management of Microsurgical Breast Reconstruction: A Systematic Review — Foppiani J et al. (2024)
• Hirudotherapy in Wound Healing — Nair H et al. (2022)

Browse all ASH-analysed research →