Coskun Kasim O, Coskun Sinan T, Popov Aron F, Hinz Jose, El-Arousy Mahmoud, Schmitto Jan D, Kececioglu Deniz, Koerfer Reiner
Department of Thoracic and Cardiovascular Surgery, University of Göttingen, Göttingen, Germany.
J Cardiothorac Surg. 2010 Nov 17;5:112. doi: 10.1186/1749-8090-5-112.
Low cardiac output (LCO) after corrective surgery remains a serious complication in pediatric congenital heart diseases (CHD). In the case of refractory LCO, extra corporeal life support (ECLS) extra corporeal membrane oxygenation (ECMO) or ventricle assist devices (VAD) is the final therapeutic option. In the present study we have reviewed the outcomes of pediatric patients after corrective surgery necessitating ECLS and compared outcomes with pediatric patients necessitating ECLS because of dilatated cardiomyopathy (DCM).
A retrospective single-centre cohort study was evaluated in pediatric patients, between 1991 and 2008, that required ECLS. A total of 48 patients received ECLS, of which 23 were male and 25 female. The indications for ECLS included CHD in 32 patients and DCM in 16 patients.
The mean age was 1.2 ± 3.9 years for CHD patients and 10.4 ± 5.8 years for DCM patients. Twenty-six patients received ECMO and 22 patients received VAD. A total of 15 patients out of 48 survived, 8 were discharged after myocardial recovery and 7 were discharged after successful heart transplantation. The overall mortality in patients with extracorporeal life support was 68%.
Although the use of ECLS shows a significantly high mortality rate it remains the ultimate chance for children. For better results, ECLS should be initiated in the operating room or shortly thereafter. Bridge to heart transplantation should be considered if there is no improvement in cardiac function to avoid irreversible multiorgan failure (MFO).
小儿先天性心脏病（CHD）矫正手术后低心输出量（LCO）仍是一种严重并发症。对于难治性LCO，体外生命支持（ECLS）、体外膜肺氧合（ECMO）或心室辅助装置（VAD）是最后的治疗选择。在本研究中，我们回顾了需要ECLS的小儿患者矫正手术后的结局，并将其与因扩张型心肌病（DCM）需要ECLS的小儿患者的结局进行比较。
对1991年至2008年间需要ECLS的小儿患者进行了一项回顾性单中心队列研究。共有48例患者接受了ECLS，其中男性23例，女性25例。ECLS的适应证包括32例CHD患者和16例DCM患者。
CHD患者的平均年龄为1.2±3.9岁，DCM患者为10.4±5.8岁。26例患者接受了ECMO，22例患者接受了VAD。48例患者中共有15例存活，8例心肌恢复后出院，7例心脏移植成功后出院。接受体外生命支持患者总的死亡率为68%。
虽然使用ECLS显示出显著的高死亡率，但它仍然是儿童的最终希望。为了获得更好的结果，应在手术室或术后不久开始使用ECLS。如果心功能没有改善，应考虑作为心脏移植的过渡，以避免不可逆的多器官功能衰竭（MFO）。
