Circulatory support devices save young lives

From the 2011 Department of Surgery Annual Report

PedPatientsBerlinHeartQuinton Bogner, Kallie Finn and Thomas Pottorff (left to right) all received Berlin Hearts at St. Louis Children’s Hospital. They have become good friends through their shared experience.TEAMWORK WAS CRITICAL for three children who recently received mechanical circulatory support devices as a bridge to heart transplant at St. Louis Children’s Hospital.

“Pediatric surgery is a team sport with three components,” says Pirooz Eghtesady, MD, PhD, chief of the Section of Pediatric Cardiothoracic Surgery at Washington University and St. Louis Children’s Hospital. “One is the judgment factor of who you operate on, when you operate, what kind of surgery you perform, should you even do surgery or should there be some other intervention. Then there is the operative component and postoperative management.”

The Washington University/St. Louis Children’s Hospital Heart Center Team — including Eghtesady and colleagues Charles Canter, MD, medical director of transplant services, and Avihu Gazit, MD, chief of the cardiac intensive care unit — worked together with referring cardiologists to determine the best course for the three children, who were too unstable to simply wait for a transplant. All survived with the help of the Berlin Heart, a pumping device available to pediatric patients as part of a national clinical trial.

Ten-year-old Thomas Pottorff, who was born with a congenital heart defect, presented the biggest challenge. He had undergone two surgeries and a valve replacement and had a pacemaker for an arrhythmia. He became a close buddy with Quinton Bogner, a 9-year-old with cardiomyopathy who shared his Berlin Heart experiences to make Thomas more at ease.

In June 2011, 4-year-old Kallie Finn became the last hospital patient to participate in the trial. Kallie had myocarditis, an inflammation of the heart muscle, and at one point her heart went into tachycardia and then stopped before she received the device.

All three children are doing well after transplant, and the Berlin Heart has received conditional approval from a Food and Drug Administration advisory panel.

To further improve communication, the Heart Center Team has implemented several initiatives: enhancing communication with referring doctors; e-mail pre-briefing among the 40 to 50 medical, nursing and other staff members involved in the surgery; and scoring of patients’ medical conditions to prioritize rounding in the ICU.

“These changes will ideally enhance team interaction and patient outcomes,” says Eghtesady.