Hsu K H, Huang S C, Chou N H, Chi N H, Tsao C I, Ko W J, Chen Y S, Chang C I, Chiu I S, Wang S S
Department of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Transplant Proc. 2012 May;44(4):883-5. doi: 10.1016/j.transproceed.2012.03.023.
There are limited options for mechanical circulatory support to treat end-stage heart failure in pediatric patients. Although extracorporeal membrane oxygenation is commonly used in infants and children, ventricular assist devices (VAD) provide a longer duration of support with fewer complications before recovery or as a bridge to heart transplantation (HTx), as described herein.
This retrospective chart review of eight patients transplanted from April 2008 to December 2011, after left ventricular assist device (LVAD) implantation due to end-stage heart failure. Their mean age was 12 years (9-15 y) and mean body weight, 48 kg (20-78). All were New York Heart Association functional class IV with mean left ventricular ejection fractions less than 15%.
The six patients (75%) received HTx after a mean LVAD support duration of 43.2 days; 2 (25%) died before a suitable heart became available. Their mean duration of LVAD support was 30 days. There were 4 (50%) who experienced clinically evident thromboembolic events: 3 (37.5%) cerebrovascular with 1 mortality and 1 (12.5%) as acute limb ischemia. Transient hemodialysis was performed in 4 (50%). Bloodstream infection identified in 6 (75%) was controlled with intravenous antibiotics. Driveline infection identified in 4 (50%) was treated successfully with local wound dressing changes and intravenous antibiotics. One 9-year-old boy died of rejection at 16 months after transplantation.
Because of the organ shortage, pediatric patients have a low chance to undergo HTx. VAD provides long-term support for children with end-stage heart failure before a suitable heart becomes available. A thromboembolic event remains a major complication influencing their survival.
在治疗小儿终末期心力衰竭时，机械循环支持的选择有限。尽管体外膜肺氧合在婴儿和儿童中常用，但如本文所述，心室辅助装置（VAD）在恢复前或作为心脏移植（HTx）的桥梁时，能提供更长时间的支持且并发症更少。
对2008年4月至2011年12月因终末期心力衰竭植入左心室辅助装置（LVAD）后接受移植的8例患者进行回顾性病历审查。他们的平均年龄为12岁（9 - 15岁），平均体重48千克（20 - 78千克）。所有患者均为纽约心脏协会心功能IV级，平均左心室射血分数低于15%。
6例患者（75%）在平均LVAD支持43.2天后接受了HTx；2例（25%）在获得合适心脏前死亡。他们的平均LVAD支持时间为30天。4例（50%）发生了临床明显的血栓栓塞事件：3例（37.5%）为脑血管事件，1例死亡，1例（12.5%）为急性肢体缺血。4例（50%）进行了临时血液透析。6例（75%）发现血流感染，通过静脉使用抗生素得到控制。4例（50%）发现驱动线感染，通过局部伤口换药和静脉使用抗生素成功治疗。1例9岁男孩在移植后16个月死于排斥反应。
由于器官短缺，小儿患者接受HTx的机会较低。VAD在合适心脏可用之前为终末期心力衰竭儿童提供长期支持。血栓栓塞事件仍然是影响他们生存的主要并发症。
