tıklayınız - Türk Pediatrik Kardiyoloji ve Kalp Cerrahisi Derneği

MECHANICAL CIRCULATORY SUPPORT IN PEDIATRIC PATIENTS
HAKAN AKINTÜRK
JUSTUS LIEBIG UNIVERSITY, GERMANY
Introduction
End stage cardiac failure in children is a frustrating diagnosis. Mechanical circulatory
support (VAD) is sometimes the only possible treatment either to bridge for
transplantation or to stabilize the circulatory situation in order to treat a transient
cardiac failure.
Methods
Between 1997 and 2011 we treated 27 patients (29 applications) in end stage cardiac
failure with different extracorporeal VAD Systems. From 1997 to 2001 we implanted
the Medos Excor (group A) in 11 patients (LVAD n=5, RVAD n=2.BiVAD n=4), median
age 2y (r: 20d-11y). Diagnosis of group A consisted of: DCM n=4, myocarditis n=2;
postcardiotomy n=2, post HTX n=2. From 2006 to 2011, the Berlin Heart System (group
B), 17 pts (19 applications) (LVAD n=7, BiVAD n=12), median age 8y (r: 95d-19y). In
group B patients suffered from DCM/RCM n=14; chronic myocarditis n=2; ischemic
cardiomypathy n=1. Application of VAD in group A was elective in 7 pts., urgent in 4
pts., in group B elective in 9, urgent in 10 procedures. ECMO was performed only in
group B in 11 patients as a bridge to VAD.
Results
In group A 5 pts. (45%) survived, 3 bridged to HTX, 2 recovered. Median VAD therapy
was 9 d (r.: 0,5-30d). 6 pts. died (ARDS n=2, brain death n=2, sepsis n=1, bleeding n=1).
In group B 12 pts. (66%) survived, 7 bridged to HTX, 4 to recovery. Median VAD time
was 30d (r:8-283d). 6 pts. (33%) died (sepsis n=4, brain death n=2). Increased risk of
mortality was associated with pre-VAD cerebral insult (odds-ratio: 12,8, infection on
VAD (odds-ratio: 5,3) and surgical revision on VAD (odds-ratio:4,2).
Conclusion
In end stage cardiac failure VAD therapy in pediatric patients is successful as a bridge
to transplant or to recovery. Serious complications are always possible, so that VADtherapy
should be postponed as long as possible. Reducing infections and bleeding
during VAD therapy is a mayor step to an improved outcome.
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