THE IMPACT OF STRATEGIC CHANGES ON PAEDIATRIC HEART FAILURE PATIENTS RECEIVING BERLIN HEART SUPPORT IN BOLOGNA

Background: Heart failure in paediatric age represents a significant challenge, and Berlin Heart (BH) ventricular assist device is frequently the only option. We evaluated the effects of recent strategic changes in BH utilization in our centre. Methods: From January 2008 to March 2024, 24 patients underwent BH implant. We divided the population in first era (FE, 2008-2016; n=13; Age 5.3 years; weight 17 kg) and second era (SE, 2017-2024; n=11; Age 6.3 years; weight 18.5 kg), (FE, 2008-2016) and second era (SE, 2017-2024), the latter characterized by a more aggressive approach in order to avoid ECMO implantation before BH. Kaplan-Meier curves have been employed to compare mortality. Results: In-hospital mortality was 32%. All survived patients underwent orthotopic heart transplantation (OHT), except one still hospitalized in BH. Comparing the two era the need for pre-operative intubation (18.2%, p=0.001) and the use of ECMO (9.1%) were greatly reduced in the SE. No biventricular BH was implanted in the SE. Kaplan-Meier analysis revealed similar survival rates in BH in the two groups. Otherwise, survival after OHT in the FE was 90%, 70% and 70% at 6months, 1year and 4years respectively, in the SE was 100% all over the follow-up period. Overall survival rates at 5 years in patients in whom ECMO wasn’t used before BH implantation was 72%, while in patients with ECMO was 50%, (log- rank=0.307). Conclusions: Our analysis may suggest how an earlier and more aggressive approach in the BH implantation in pediatric patients with heart failure avoiding the use of ECMO may improve long-term survival. ECMO could be risk factor of mortality.