Artificial heart provides bridge to transplant

From the 2012 Department of Surgery Annual Report

PedPatientSBA ventricular-assist device supported circulation for Stanislaw Bartlett until he could receive a heart transplant at age 4.Stanislaw “Stas ” Bartlett was gravely ill when he was transported to St. Louis Children’s Hospital by medical helicopter in November 2011. A few months short of his fourth birthday, he already had undergone two surgeries for a congenital heart defect. He was listed for heart transplantation, but needed extensive therapy to bridge him to a successful transplant in April 2012.

“Stas was born with single ventricle anatomy,” says Pirooz Eghtesady, MD, chief of pediatric cardiothoracic surgery at The St. Louis Children’s and Washington University Heart Center. “Essentially, part of his heart never formed completely, and the blood flow to his lungs was dependent on passive circulation. There was no chamber pumping blood through his lungs.”

Two months after he was born, Stas had undergone a procedure to prepare his heart for a second corrective surgery he would need a few years later to correct his heart physiology. Shortly after that second surgery in October 2011, his heart began to fail. In November, his mother, Rebecca, took him to Children’s Hospital & Medical Center in Omaha, Neb., and from there he was flown to St. Louis Children’s Hospital.

The FDA had recently approved the use of the Berlin Heart, a ventricular-assist device, as a bridge to transplant in children. But the device had not been used very effectively in patients with single-ventricle physiology. Instead, doctors started Stas on drugs to help his heart contract and later placed him on a ventilator. When his circulation continued to deteriorate, doctors tried implanting the Impella cardiac-assist device, which caused kidney dysfunction, then removed it and employed a different cardiac-support technique called extracorporeal membrane oxygenation (ECMO).

ECMO is only used for short-term cardiac support and wasn’t helping much. The Berlin Heart offered a way to restore circulation and organ function, but there was a risk it would not help Stas. With limited options, Stas’ family agreed to try the device, and Eghtesady performed a 12-hour operation in which he modified the implantation.

Rebecca Bartlett saw Stas improve after the Berlin implantation, and he received his new heart 27 days later. She reported Stas was gaining strength and behaving like a normal 4-year-old two months after the surgery.

“Stas is the first child with single ventricle anatomy to be bridged successfully to heart transplantation. He also is unusual in that he was sicker than most children who undergo heart transplant,” says Eghtesady. “But I’m happy to say that his longterm prognosis is similar to that of any other child receiving a heart transplant.”