Gazit Avihu Z, Petrucci Orlando, Manning Peter, Shepard Mark, Baltagi Sirine, Simpson Kathleen, Castleberry Chesney, Canter Charles, Eghtesady Pirooz
Division of Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri; Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Ann Thorac Surg. 2017 Nov;104(5):1630-1636. doi: 10.1016/j.athoracsur.2017.04.023. Epub 2017 Jul 15.
Historically, the options for mechanical circulatory support in infants, particularly those with single-ventricle physiology, have been limited and outcomes have generally been poor. We report a new approach implemented for long-term support in a series of such patients.
This study is a single-center case series of 7 patients with single-ventricle physiology after stage 1 palliation supported with mechanical circulatory support using a novel technique, between May 2014 and September 2015. Our technique included modification and implantation of commercially available pediatric cannulae into the common atrium and the ascending aorta or reconstructed neoaorta and utilization of a centrifugal extracorporeal pump.
Median circulatory support duration was 64 days (range, 35 to 99). One adverse neurologic event was observed in 1 patient, and bleeding requiring reoperation in 2 patients. Support to recovery, decision, or heart transplantation was accomplished in all cases. Of all patients, 43% were successfully discharged home.
Our experience shows that long-term extracorporeal mechanical circulatory support of patients with underlying single-ventricle physiology after stage 1 palliation is feasible utilizing our technique. This approach overcomes several major challenges encountered in these patients, such as high flow requirement and stability of the cannulae, and allows extubation, rehabilitation, and at times, myocardial recovery.
从历史上看，婴儿机械循环支持的选择，尤其是那些具有单心室生理特征的婴儿，一直很有限，而且总体预后较差。我们报告了一种在一系列此类患者中实施的长期支持新方法。
本研究是一项单中心病例系列研究，在2014年5月至2015年9月期间，对7例单心室生理特征的患者在一期姑息治疗后使用一种新技术进行机械循环支持。我们的技术包括将市售儿科套管进行改良并植入共同心房和升主动脉或重建的新主动脉，并使用离心式体外泵。
循环支持的中位持续时间为64天（范围35至99天）。1例患者发生1次不良神经事件，2例患者因出血需要再次手术。所有病例均实现了支持至恢复、决策或心脏移植。所有患者中，43%成功出院回家。
我们的经验表明，利用我们的技术，对一期姑息治疗后具有潜在单心室生理特征的患者进行长期体外机械循环支持是可行的。这种方法克服了这些患者遇到的几个主要挑战，如高流量需求和套管稳定性，并允许拔管、康复，有时还能实现心肌恢复。
