CHUV: a child on bi-ventricular cardiac assistance could be weaned off the machine and avoid a heart transplant
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After spending a year in the Pediatric Intensive Care Unit at CHUV, a 4-year-old boy did not need a heart transplant in the end: his heart now beats “on its own”. Multidisciplinary care made it possible to carry out this technical and risky operation, never before attempted at the CHUV.
This patient’s story is out of the ordinary. He arrived at the CHUV at the age of 3, in the early summer of 2022, to be treated for cancer. A few weeks after his hospitalization, he developed heart failure due to an infection that weakened his heart. Because of his oncological treatment, the child could not be put on the waiting list for a heart transplant. His heart could no longer do its job as a pump, so the boy was placed on bi-ventricular cardiac assistance – thanks to “Berlin Heart Excor”, an external device “connected” to the organ – to relieve and help his ailing heart.
Multidisciplinary care
The pediatric cardiac surgery team at CHUV first operated on the child to install the device on both ventricles. This machine is reserved exclusively for children suffering from heart failure, and saves time by preserving the heart for an eventual transplant.
A serious and unfortunately frequent complication of this cardiac assistance device is the formation of blood clots, which can lead to stroke. “The longer the device is in use, the greater the risk,” explains Dr. Marie-Hélène Perez, head physician and head of the CHUV’s Pediatric Intensive Care Unit, which specializes in the care of young patients requiring constant monitoring. Close collaboration between pediatric cardiac surgery specialists, intensivists and cardiologists is therefore essential to avoid as far as possible these complications, which can sometimes lead to a dramatic outcome.
This little boy was hospitalized on our unit for a year,” says Dr. Marie-Hélène Perez. Over time, we developed a strong bond with him and his family. To give them more freedom, we taught the parents how to familiarize themselves with the machine. Thanks to this, they could leave the unit while remaining within the perimeter of the CHUV.”
Signs that the heart was recovering
A few months after fitting the machine, the team and the parents observed signs that the heart was recovering.”During a follow-up ultrasound, I saw that a competition was developing between the heart and the machine. That’s when the idea of weaning the child off life support, without the need for a transplant, began to germinate,” explains Dr. Stefano Di Bernardo, pediatric cardiologist and senior physician at the CHUV’s Pediatrics Department.The parents therefore decided to take the risk of weaning.
To be able to remove the device and maximize the chances of success, the team followed a very strict protocol to remuscitate the heart with the help of a drug that increases the strength of cardiac contraction and prepares it to function autonomously.
CHUV activates its network for a risky operation
We decided to remove the machine and keep his native heart,” explains Prof. Reza Hosseinpour, chief physician and pediatric cardiac surgeon at CHUV. This was an unprecedented exercise in Lausanne, and a perilous one in more ways than one. Firstly, because it involved removing not just one, but both ventricles from the machine. And secondly, because in principle, the device is removed in order to transplant a new heart. In this case, the challenge was to remove the machine without damaging the existing tissue. It was a real piece of lace.
To carry out the bi-ventricular weaning operation in the CHUV’s operating theatre, Prof. Hosseinpour was accompanied by surgeon Fabrizio De Rita, a specialist from Newcastle (England) who is very familiar with the procedure. “His presence was a great help.
He accompanied me and showed me the pitfalls to avoid, but none of this would have been possible without the help of the whole OR team, the anaesthetists, perfusionists, instrument technicians and ward assistants”, says Pr Hosseinpour.
The operation lasted an entire morning and was a success. The child was able to leave intensive care just a few days after the operation, and return home a month later. In remission from his cancer, he is now being treated as an outpatient at the CHUV. We went through a terrible rollercoaster, but we kept the faith and fought through it all,” says his dad. When we got home, our son went straight to his room and started playing with his train, as if he’d left it the day before.”
📸 Picture: ©CHUV
From left to right: Dr. Sylvain Mauron (Associate Pediatric Anesthesiologist), M. Guillaume Besse (Berlin Heart Clinical Specialist), Dr Marie-Hélène Perez (Senior Physician, Head of Pediatric Intensive Care), Dr Fabrizio De Ritta (Pediatric Cardiac Surgeon), Pr Reza Hosseinpour (Senior Physician, Head of Pediatric Cardiac Surgery), Dr Stefano Di Bernardo (Senior Physician, Pediatric Cardiology) and Mr Philipp Zrunek (Berlin Heart Clinical Specialist).
▶️ Source: CHUV