Merkle Frank, Boettcher Wolfgang, Stiller Brigitte, Hetzer Roland
Academy for Perfusion, Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin, Germany.
J Extra Corpor Technol. 2003 Jun;35(2):115-20.
Mechanical cardiac assistance for neonates, infants, children and adolescents may be accomplished with pulsatile ventricular assist devices (VAD) instead of extracorporeal membrane oxygenation or centrifugal pumps. The Berlin Heart VAD consists of extracorporeal, pneumatically driven blood pumps for pulsatile univentricular or biventricular assistance for patients of all age groups. The blood pumps are heparin-coated. The stationary driving unit (IKUS) has the required enhanced compressor performance for pediatric pump sizes. The Berlin Heart VAD was used in a total number of 424 patients from 1987 to November 2001 at our institution. In 45 pediatric patients aged 2 days-17 years the Berlin Heart VAD was applied for long-term support (1-111 days, mean 20 days). There were three patient groups: Group I: "Bridge to transplantation" with various forms of cardiomyopathy (N = 21) or chronic stages of congenital heart disease (N = 9); Group II: "Rescue" in intractable heart failure after corrective surgery for congenital disease (N = 7) or in early graft failure after heart transplantation (N = 1); and Group III: "Acute myocarditis" (N = 7) as either bridge to transplantation or bridge to recovery. Seventeen patients were transplanted after support periods of between 4 and 111 days with 12 long-term survivors, having now survived for up to 10 years. Five patients (Groups I and III) were weaned from the system with four long-term survivors. In Group II only one patient survived after successful transplantation. Prolonged circulatory support with the Berlin Heart VAD is an effective method for bridging until cardiac recovery or transplantation in the pediatric age group. Extubation, mobilization, and enteral nutrition are possible. For long-term use, the Berlin Heart VAD offers advantages over centrifugal pumps and ECMO in respect to patient mobility and safety.
对于新生儿、婴儿、儿童和青少年，可使用搏动性心室辅助装置（VAD）来实现机械性心脏辅助，而非体外膜肺氧合或离心泵。柏林心脏VAD由体外气动驱动血泵组成，用于为所有年龄组的患者提供搏动性单心室或双心室辅助。血泵采用肝素涂层。固定式驱动单元（IKUS）具备适用于儿科泵尺寸所需的增强型压缩机性能。1987年至2001年11月期间，我们机构共对424例患者使用了柏林心脏VAD。在45例年龄为2天至17岁的儿科患者中，柏林心脏VAD用于长期支持（1至111天，平均20天）。有三个患者组：第一组：“过渡到移植”，患有各种形式的心肌病（N = 21）或先天性心脏病慢性阶段（N = 9）；第二组：先天性疾病矫正手术后难治性心力衰竭（N = 7）或心脏移植后早期移植物功能衰竭（N = 1）时的“抢救”；第三组：“急性心肌炎”（N = 7），作为过渡到移植或过渡到康复。17例患者在4至111天的支持期后接受了移植，其中12例长期存活，目前已存活长达10年。5例患者（第一组和第三组）脱离了该系统，4例长期存活。在第二组中，只有1例患者在成功移植后存活。使用柏林心脏VAD进行长期循环支持是儿科年龄组过渡到心脏恢复或移植的有效方法。拔管、活动和肠内营养都是可行的。就患者的活动能力和安全性而言，长期使用时，柏林心脏VAD比离心泵和体外膜肺氧合具有优势。
