Use of assist devices and ECMO to bridge pediatric patients with cardiomyopathy to transplantation
- 1 July 2002
- journal article
- Published by Elsevier BV in The Journal of Heart and Lung Transplantation
- Vol. 21 (7), 760-770
- https://doi.org/10.1016/s1053-2498(02)00386-8
Abstract
Pulsatile ventricular assist devices (VADs) are used to bridge adults with end-stage heart disease to transplantation. A combination of external implantable pulsatile and continuous-flow external mechanical support now can be used to bridge pediatric patients with end-stage cardiomyopathy to orthotopic heart transplantation (OHT). We reviewed consecutive pediatric patients with cardiomyopathy (n = 28) who required mechanical cardiac support from July 1995 to February 2001. All were OHT candidates with severe hemodynamic compromise despite maximal medical support. We excluded from this series patients who had undergone cardiotomy. Nineteen patients received support from external continuous-flow devices, either with extracorporeal membrane oxygenation or with centrifugal VADs, and 9 patients received pulsatile support. Nineteen of 28 (68%) patients were successfully bridged to transplant (17) or weaned (2) from their devices after recovery. Of the patients successfully bridged to transplant or recovery, 89% are alive to date. Univariate analysis revealed that a lower bilirubin concentration after 2 days of support was associated with a favorable outcome (p = 0.006). As expected, the patients with pulsatile VADs had significantly higher rates of extubation and oral feeding. Pulsatile and continuous-flow devices can complement each other to significantly extend the lives of a wide range of pediatric patients with severe cardiomyopathies.Keywords
This publication has 17 references indexed in Scilit:
- Mechanical assist strategy using the BVS 5000i for patients with heart failureThe Annals of Thoracic Surgery, 2000
- Cardiomyopathy and heart transplantation in childrenCurrent Opinion in Cardiology, 2000
- Morbidity and Outcome After Mechanical Ventricular Support Using Thoratec, Novacor, and HeartMate for Bridging to Heart TransplantationArtificial Organs, 2000
- Minimally invasive mechanical cardiac support without extracorporeal membrane oxygenation in children awaiting heart transplantation.The Annals of Thoracic Surgery, 1999
- Application of ventricular assist systems for end-stage cardiomyopathy patients as a bridge to heart transplant or recoveryTransplantation Proceedings, 1999
- The State of Pediatric Heart TransplantationAACN Advanced Critical Care, 1999
- Mechanical circulatory support in children with cardiac diseaseThe Journal of Thoracic and Cardiovascular Surgery, 1999
- Circulatory support with pneumatic paracorporeal ventricular assist device in infants and childrenThe Annals of Thoracic Surgery, 1998
- Intermediate and long-term results after pediatric heart transplantation: incidence and role of pretransplant diagnosisTransplant International, 1998
- Ventricular assist systems: Experience in Japan with Toyobo pump and Zeon pumpThe Annals of Thoracic Surgery, 1996