Berlin Heart EXCOR in pediatric heart failure: Bridging long-lasting and complex conditions to transplant.

BACKGROUND: Advanced heart failure (advHF) in pediatric patients often requires prolonged mechanical circulatory support (MCS) as a bridge-to-transplant or bridge-to-recovery. Due to donor scarcity and anatomical complexity, pediatric patients frequently face long MCS durations and high complication risks. The Berlin Heart EXCOR is an approved ventricular assist device (VAD) with versatile configurations adaptable to specific patient needs. METHODS: This study analyzed demographic, clinical, echocardiographic, and hemodynamic data from the Heart Transplant Unit at ASST-Papa Giovanni XXIII (Bergamo, Italy). The research focused on advHF management using prolonged MCS as a bridge-to-transplant, detailing Berlin Heart EXCOR configurations, settings, support duration, and complications. RESULTS: Three pediatric patients with distinct etiologies received prolonged MCS via Berlin Heart EXCOR. The first, with genetic dilated cardiomyopathy, required a left ventricular EXCOR. The second, with early-onset cardiomyopathy and biventricular failure, received biventricular support. The third, with complex congenital heart disease (CHD), was supported by a single EXCOR. Despite varying ages and cardiac anatomies, all three patients were successfully bridged to heart transplantation without irreversible extracardiac organ damage. CONCLUSIONS: This case series demonstrates the effectiveness of long-lasting MCS in providing sustained hemodynamic stability for pediatric patients. The Berlin Heart EXCOR proved to be a reliable long-term support option in both univentricular and biventricular settings.