Department of Surgery, University of California San Diego, San Diego, CA, USA.
Artif Organs. 2011 Nov;35(11):1018-23. doi: 10.1111/j.1525-1594.2011.01391.x.
Anticoagulation of children on mechanical circulatory support presents a challenge. We implanted 28 devices in children and infants using a consistent anticoagulation protocol. We performed a retrospective review of all children implanted in our program with mechanical assist devices since 1997. Heparin, dipyridamole, and aspirin were used for anticoagulation and antiaggregation. Coagulation monitoring included thromboelastography (TEG), platelet aggregration studies, international normalized ratio, partial thromboplastin time, and platelet count. Twenty-eight children, ages 1 month to 16 years (mean 5.3; median 2.4 years), were implanted for 3-107 days (mean 27; median 17). Eighteen received left ventricular assist devices, seven received biventricular assist devices, and three received total artificial hearts. Adverse events during the 720 days of device support included the following: six (21%) reoperations for bleeding; seven strokes (25%): two fatal, two with a mild residual deficit, and three without deficit; and three (11%) visceral emboli: two fatal and one nonfatal. There were eight deaths (29%). Causes of death were embolic (four), graft failure post-transplantation (one), preimplant anoxic brain damage (two), and postexplant heart failure (one). 24/28 (86%) survived to transplantation or weaning from device and 20/28 (71%) were discharged from the hospital, 10 after transplantation and 10 after native heart recovery. All 20 early survivors survived long term. We describe an anticoagulation protocol based upon TEG and platelet aggregation studies and using heparin, aspirin, and dipyridamole. Adequate anticoagulation is more difficult in children. However, 71% of the patients in our study survived long term.
儿童在机械循环支持下的抗凝治疗是一个挑战。我们采用一致的抗凝方案，为 28 名儿童和婴儿植入了 28 种设备。我们对自 1997 年以来在我们的机械辅助设备项目中植入机械辅助设备的所有儿童进行了回顾性研究。肝素、双嘧达莫和阿司匹林用于抗凝和抗聚集。凝血监测包括血栓弹性描记术（TEG）、血小板聚集研究、国际标准化比值、部分凝血活酶时间和血小板计数。28 名儿童的年龄为 1 个月至 16 岁（平均 5.3 岁；中位数 2.4 岁），植入时间为 3-107 天（平均 27 天；中位数 17 天）。18 名儿童接受左心室辅助装置，7 名儿童接受双心室辅助装置，3 名儿童接受全人工心脏。在 720 天的设备支持期间，出现了以下不良事件：6 例（21%）因出血而再手术；7 例（25%）中风：2 例致命，2 例轻度残留缺陷，3 例无缺陷；3 例（11%）内脏栓塞：2 例致命，1 例非致命。有 8 例死亡（29%）。死亡原因分别为栓塞（4 例）、移植后移植物衰竭（1 例）、植入前缺氧性脑损伤（2 例）和植除后心力衰竭（1 例）。28 例中 24 例（86%）存活至移植或成功脱离设备，20 例（71%）出院，10 例在移植后出院，10 例在恢复自身心脏后出院。所有 20 例早期幸存者均长期存活。我们描述了一种基于 TEG 和血小板聚集研究的抗凝方案，使用肝素、阿司匹林和双嘧达莫。在儿童中，充分抗凝更具挑战性。然而，我们研究中的 71%的患者长期存活。
