Cardiothoracic and Vascular Surgery, Montefiore Medical Center, New York, NY.
Cardiothoracic and Vascular Surgery, Montefiore Medical Center, New York, NY.
J Thorac Cardiovasc Surg. 2014 Feb;147(2):697-704; discussion 704-5. doi: 10.1016/j.jtcvs.2013.10.030. Epub 2013 Nov 28.
The frequency and successful use of pediatric ventricular assist devices (VADs) as a bridge to cardiac transplantation have been steadily increasing since 2003, but the experience in patients with complex congenital heart disease has not been well described. Using a large prospectively collected dataset of children supported with the Berlin Heart EXCOR VAD, we have reviewed the experience in children with single ventricular anatomy or physiology (SV), and compared the results with those supported with biventricular circulation (BV) over the same time period.
The EXCOR Investigational Device Exemption study database was retrospectively reviewed. VAD implants under the primary cohort and compassionate use cohort between May 2007 and December 2011 were included in this review.
Twenty-six of 281 patients supported with a VAD were SV. The most common diagnosis was hypoplastic left heart syndrome (15 of 26). Nine patients were supported after neonatal palliative surgery (Blalock-Taussig shunt or Sano), 12 after a superior cavopulmonary connection (SCPC), and 5 after total cavopulmonary connection (TCPC). Two patients received biventricular assist devices, 1 after stage I surgery and 1 after stage II. SV patients were supported for a median time of 10.5 days (range, 1-363 days) versus 39 days (range, 0-435 days) for BV (P = .01). The ability to be bridged to transplant or recovery in SV patients is lower than for BV patients (11 of 26 [42.3%] vs 185 of 255 [72.5%]; P = .001). Three of 5 patients with TCPC were successfully bridged to transplant and were supported with 1 VAD. Seven of 12 patients with SCPC were bridged to transplant, and only 1 of 9 patients supported after a stage I procedure survived.
The EXCOR Pediatric VAD can provide a bridge to transplant for children with SV anatomy or physiology, albeit less successfully than in children with BV. In this small series, results are better in patients with SCPC and TCPC. VAD support for patients with shunted sources of pulmonary blood flow should be applied with caution.
自 2003 年以来，儿科心室辅助设备（VAD）作为心脏移植桥接的频率和成功使用一直在稳步增加，但复杂先天性心脏病患者的经验尚未得到很好的描述。我们使用大量前瞻性收集的柏林心脏 EXCOR VAD 支持儿童的数据，回顾了具有单心室解剖结构或生理学（SV）的儿童的经验，并将结果与同一时期接受双心室循环（BV）支持的结果进行了比较。
回顾性审查 EXCOR 调查设备豁免研究数据库。2007 年 5 月至 2011 年 12 月，在主要队列和同情使用队列下植入 VAD 的患者均包括在本回顾中。
281 名接受 VAD 支持的患者中有 26 名 SV。最常见的诊断是左心发育不全综合征（15 例）。9 例患者接受了新生儿姑息性手术（Blalock-Taussig 分流术或 Sano），12 例患者接受了上腔静脉-肺动脉连接术（SCPC），5 例患者接受了全腔静脉-肺动脉连接术（TCPC）。2 例患者接受了双心室辅助设备，1 例在 1 期手术后，1 例在 2 期手术后。SV 患者的中位支持时间为 10.5 天（范围，1-363 天），而 BV 患者为 39 天（范围，0-435 天）（P =.01）。SV 患者能够桥接到移植或恢复的能力低于 BV 患者（26 例中有 11 例[42.3%]，255 例中有 185 例[72.5%]；P =.001）。5 例 TCPC 患者中有 3 例成功桥接到移植，其中 1 例接受 1 个 VAD 支持。12 例 SCPC 患者中有 7 例桥接到移植，而仅 1 例接受 1 期手术的患者存活。
EXCOR 儿科 VAD 可为 SV 解剖结构或生理学的儿童提供移植桥接，但不如 BV 儿童成功。在这个小系列中，SCPC 和 TCPC 的结果更好。应谨慎应用于分流肺血流量源的患者的 VAD 支持。
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