Van Dorn Charlotte S, Aganga Devon O, Johnson Jonathan N
Department of Pediatrics/Division of Pediatric Cardiology.
Department of Pediatrics/Division of Critical Care Medicine.
Curr Opin Cardiol. 2018 Jan;33(1):87-94. doi: 10.1097/HCO.0000000000000479.
Mechanical circulatory support (MCS) has become an indispensable tool in the management of children with impending respiratory and cardiac failure. Though extracorporeal membrane oxygenation (ECMO) was classically the only form of support available to pediatric patients, considerable advances have allowed ventricular assist devices (VADs) to become increasingly utilized in children. This review provides an update of recent advances in ECMO and VAD management in children.
The options for mechanical support in infants and small children with end-stage heart failure are limited. As such, the greatest advances in the past decade have come in the successful adoption of the Berlin Heart EXCOR device, with a marked improvement in survival to transplant over ECMO. Further advances have been made in the use of adult VADs in children. For instance, the HeartWare HVAD has been utilized in children as young as 3 years of age, despite being designed for use in adult patients.
The availability of mechanical support options for children remains limited to ECMO and a small number of VADs. While outcomes of VAD support in pediatric patients have been promising, further study in smaller and more complex pediatric patients is necessary.
机械循环支持（MCS）已成为治疗即将发生呼吸和心力衰竭儿童的不可或缺的工具。虽然体外膜肺氧合（ECMO）传统上是儿科患者唯一可用的支持形式，但取得的重大进展使心室辅助装置（VAD）在儿童中的应用越来越广泛。本综述介绍了儿童ECMO和VAD管理的最新进展。
患有终末期心力衰竭的婴幼儿机械支持选择有限。因此，过去十年中最大的进展是成功采用了柏林心脏EXCOR装置，与ECMO相比，移植生存率有显著提高。在儿童使用成人VAD方面也取得了进一步进展。例如，HeartWare HVAD尽管设计用于成人患者，但已在年仅3岁的儿童中使用。
儿童机械支持选择仍然仅限于ECMO和少数VAD。虽然儿科患者VAD支持的结果很有前景，但有必要对更小、更复杂的儿科患者进行进一步研究。
