Pediatrics and Anesthesiology, Stanford Hospitals and Clinics.
Stanford University School of Medicine.
J Heart Lung Transplant. 2016 Jan;35(1):92-98. doi: 10.1016/j.healun.2015.06.006. Epub 2015 Jun 17.
Limited availability of donor organs has led to the use of ventricular assist devices (VADs) to treat heart failure in pediatric patients, primarily as bridge to transplantation. How effective VAD therapy is in promoting functional recovery in children is currently not known.
We report morbidity and mortality as defined by the Interagency Registry for Mechanically Assisted Circulatory Support Modified for Pediatrics (PediMACS) and the use of the Treatment Intensity Score to assess functional status for 50 VAD patients supported at a single pediatric program from 2004 to 2013.
In this cohort, 30-day survival on VAD was 98%, and 180-day survival was 83%. Stroke occurred in 11 patients (22%), with 8 (16%) resulting in persistent neurologic deficit or death. The adverse event rate was 2-fold to 3-fold higher in the first 7 days of support compared with the subsequent support period. Functional status, as measured by the Treatment Intensity Score, improved with duration of support. Successful bridge to transplantation was associated with fewer adverse events during support and greater improvement in the Treatment Intensity Score during the period of support.
Overall survival in this cohort is excellent. The risk of serious adverse events decreases over the first month of support. However, a clinically significant risk of morbidity and mortality persists for the duration of pediatric VAD support. Measures of functional status improve with duration of support and are associated with survival to transplantation.
供体器官的有限供应导致心室辅助装置（VAD）用于治疗儿科患者的心力衰竭，主要作为移植前的桥接治疗。目前尚不清楚 VAD 治疗在促进儿童心功能恢复方面的效果如何。
我们报告了由儿科机械循环辅助支持机构注册处（PediMACS）定义的发病率和死亡率，以及使用治疗强度评分来评估 2004 年至 2013 年在单一儿科项目中接受 50 例 VAD 支持的患者的功能状态。
在该队列中，VAD 的 30 天生存率为 98%，180 天生存率为 83%。11 例患者（22%）发生卒中，其中 8 例（16%）导致持续的神经功能缺损或死亡。与随后的支持期相比，支持的前 7 天不良事件发生率是其后的 2 至 3 倍。功能状态，如治疗强度评分所示，随支持时间的延长而改善。成功桥接移植与支持期间不良事件减少和治疗强度评分改善有关。
该队列的总生存率非常好。在支持的第一个月，严重不良事件的风险降低。然而，儿科 VAD 支持期间仍然存在显著的发病率和死亡率风险。功能状态的测量指标随支持时间的延长而改善，并与移植后的生存相关。
