Mongé Michael C, Kulat Bradley T, Eltayeb Osama, Zingle Neale R, Moss Steven T, Gossett Jeffrey G, Pahl Elfriede, Costello John M, Backer Carl L
Divisions of Cardiovascular-Thoracic Surgery, Chicago, IL, USA.
Departments of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Artif Organs. 2017 Jan;41(1):25-31. doi: 10.1111/aor.12881.
A continuous flow extracorporeal ventricular assist device (VAD) was modified to support functionally univentricular infants and children awaiting heart transplantation. A centrifugal VAD, designed to flow from 1.5 to 8 L/min, was used as a bridge-to-transplant in four patients with functionally univentricular circulation. A variable restrictive recirculation shunt permitted lower flow ranges in small patients. In hypoxic patients, an oxygenator was incorporated into the circuit. From 2012 to 2015, the modified VAD was placed in four patients with Glenn physiology. Age ranged from 0.97 to 6.98 years (median = 2.2 yrs). Body surface area ranged from 0.41 to 0.84 m (median = 0.54 m ). One patient was on extracorporeal membrane oxygenation prior to VAD. A recirculation shunt was used in three patients. Three patients required temporary use of an oxygenator for 4, 10, and 27 days. Median time on the VAD was 32.3 days (range = 23-43 days). A decrease in the cavopulmonary pressure was noted in all patients, as was a fall in the B-type natriuretic peptide. Three patients survived transplant and were discharged at 28-82 days post-transplantation. One patient died after 35 days of support. Two patients experienced major bleeding events. Two patients experienced cerebrovascular accidents, one major and one minor. The centrifugal VAD successfully supported palliated functionally univentricular patients awaiting heart transplantation. The modified recirculation shunt facilitated the successful support of patients in whom optimal flows were substantially lower than that recommended by the manufacturer. The continuous-flow VAD effectively decompressed the cavopulmonary system. The design allowed placement of an in-line oxygenator in hypoxic patients. Further investigation is required to decrease the thromboembolic events, and associated morbidity, in patients supported with this device.
一种连续流体外心室辅助装置（VAD）被改良，用于支持等待心脏移植的功能性单心室婴幼儿。一种设计流量为1.5至8升/分钟的离心式VAD，被用作4例功能性单心室循环患者的移植过渡装置。可变限流再循环分流器允许小患者使用更低的流量范围。对于低氧患者，回路中加入了氧合器。2012年至2015年，改良后的VAD被植入4例具有格林分流生理状态的患者体内。年龄范围为0.97至6.98岁（中位数=2.2岁）。体表面积范围为0.41至0.84平方米（中位数=0.54平方米）。1例患者在植入VAD前接受了体外膜肺氧合治疗。3例患者使用了再循环分流器。3例患者需要临时使用氧合器4天、10天和27天。VAD使用的中位时间为32.3天（范围=23 - 43天）。所有患者的腔肺压力均下降，B型利钠肽也降低。3例患者存活至移植并在移植后28 - 82天出院。1例患者在支持治疗35天后死亡。2例患者发生大出血事件。2例患者发生脑血管意外，1例严重，1例轻微。离心式VAD成功地支持了等待心脏移植的姑息性功能性单心室患者。改良后的再循环分流器有助于成功支持那些最佳流量远低于制造商推荐值的患者。连续流VAD有效地减轻了腔肺系统的压力。该设计允许在低氧患者中放置在线氧合器。需要进一步研究以减少使用该装置支持的患者中的血栓栓塞事件及相关发病率。
