Potapov Evgenij V, Stiller Brigitte, Hetzer Roland
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany.
Pediatr Transplant. 2007 May;11(3):241-55. doi: 10.1111/j.1399-3046.2006.00611.x.
Mechanical circulatory support systems for the treatment of acute and chronic heart failure are now available for use in several clinical situations and are designed for different indications and support times. In children, particularly in small infants, extracorporeal membrane oxygenation and centrifugal pumps have been most widely used in the past. These systems are preferred for support after cardiac operations and for use in patients who have concomitant respiratory failure, but they are suitable for short-term application only and intensive care is obligatory. VADs are designed for long-term application and allow patients to be discharged home. Pneumatic pulsatile VADs have been available in pediatric sizes since 1992. Currently at our institution, 74 children have been supported with pediatric extracorporeal VADs for up to 14 months. In the past five yr, a notable rise in survival has been achieved by improvements in pump design and pre- and post-operative management. We have been able to discharge 78% of the infants under one yr old. In this review, our current VAD experience in children will be presented in the light of improvements in decision-making, device technology, and implantation techniques, and in coagulation monitoring and anticoagulation. Additionally, new developments in the field of pediatric assist devices will be presented.
用于治疗急慢性心力衰竭的机械循环支持系统目前可用于多种临床情况，并且针对不同的适应症和支持时间进行了设计。在儿童中，尤其是小婴儿，过去体外膜肺氧合和离心泵应用最为广泛。这些系统在心脏手术后的支持以及伴有呼吸衰竭的患者中使用较为理想，但它们仅适用于短期应用，且必须进行重症监护。心室辅助装置（VAD）专为长期应用而设计，可让患者出院回家。自1992年以来，就有适合儿科使用尺寸的气动搏动性VAD。目前在我们机构，已有74名儿童接受了儿科体外VAD支持长达14个月。在过去五年中，通过泵设计以及术前和术后管理的改进，生存率有了显著提高。我们已能够让78%的一岁以下婴儿出院。在本综述中，我们将根据决策制定、设备技术、植入技术以及凝血监测和抗凝方面的改进，介绍我们目前在儿童VAD方面的经验。此外，还将介绍儿科辅助装置领域的新进展。
