Sandrio Stany, Springer Wolfgang, Karck Matthias, Gorenflo Matthias, Weymann Alexander, Ruhparwar Arjang, Loukanov Tsvetomir
1Department of Cardiac Surgery,University of Heidelberg,Heidelberg,Germany.
2Department of Paediatric Cardiology,University of Heidelberg,Heidelberg,Germany.
Cardiol Young. 2014 Aug;24(4):654-60. doi: 10.1017/S1047951113001017. Epub 2013 Aug 6.
The aim of this study was to evaluate our experience in central extracorporeal life support with an integrated left ventricular vent in children with cardiac failure.
Eight children acquired extracorporeal life support with a left ventricular vent, either after cardiac surgery (n = 4) or during an acute cardiac illness (n = 4). The ascending aorta and right atrium were cannulated. The left ventricular vent was inserted through the right superior pulmonary vein and connected to the venous line on the extracorporeal life support such that active left heart decompression was achieved.
No patient died while on support, seven patients were successfully weaned from it and one patient was transitioned to a biventricular assist device. The median length of support was 6 days (range 5-10 days). One patient died while in the hospital, despite successful weaning from extracorporeal life support. No intra-cardiac thrombus or embolic stroke was observed. No patient developed relevant intracranial bleeding resulting in neurological dysfunction during and after extracorporeal life support.
In case of a low cardiac output and an insufficient inter-atrial shunt, additional left ventricular decompression via a vent could help avoid left heart distension and might promote myocardial recovery. In pulmonary dysfunction, separate blood gas analyses from the venous cannula and the left ventricular vent help detect possible coronary hypoxia when the left ventricle begins to recover. We recommend the use of central extracorporeal life support with an integrated left ventricular vent in children with intractable cardiac failure.
本研究的目的是评估我们在心力衰竭儿童中使用集成左心室引流管进行中心体外膜肺氧合支持的经验。
8名儿童接受了带左心室引流管的体外膜肺氧合支持，其中4名在心脏手术后，4名在急性心脏疾病期间。分别对升主动脉和右心房进行插管。左心室引流管经右上肺静脉插入，并连接到体外膜肺氧合支持装置的静脉管路，以实现左心有效减压。
在接受支持期间无患者死亡，7名患者成功撤机，1名患者过渡到双心室辅助装置。支持的中位时长为6天（范围5 - 10天）。1名患者尽管成功撤机，但在住院期间死亡。未观察到心内血栓或栓塞性卒中。在体外膜肺氧合支持期间及之后，无患者发生导致神经功能障碍的相关颅内出血。
在心输出量低且房水平分流不足的情况下，通过引流管进行额外的左心室减压有助于避免左心扩张，并可能促进心肌恢复。在肺功能障碍时，分别对静脉插管和左心室引流管进行血气分析有助于在左心室开始恢复时检测可能的冠状动脉缺氧情况。我们建议在难治性心力衰竭儿童中使用带集成左心室引流管的中心体外膜肺氧合支持。
