Department of Cardiac Surgery, Heart Transplantation and Mechanical Circulatory Support for Children, Silesian Centre for Heart Diseases, Zabrze, Poland.
Department of Cardiac Surgery, Heart Transplantation and Mechanical Circulatory Support for Children, Silesian Centre for Heart Diseases, Zabrze, Poland
Kardiol Pol. 2018;76(1):83-90. doi: 10.5603/KP.a2017.0201. Epub 2017 Nov 23.
The treatment of advanced heart failure (HF) in children and infants poses a serious management problem. Heart failure in that patient group is usually of congenital aetiology. The treatment schedules for paediatric patients are in most cases adapted from the guidelines for treatment of adults. Up to 2009, the treatment of that extremely difficult group of patients was limited to pharmacological therapy and occasional heart transplantations. Constantly increasing problems with recruiting donors, especially for the paediatric group, contribute to the fact that mechanical support with the use of ventricular assist devices is for many children the only chance of surviving the period of waiting for a heart donor.
The aim of the study was to analyse the outcomes of circulatory support in Poland and to assess the advisability of this method for treatment of children with severe HF.
This treatment of paediatric patients is currently used in three Polish centres. From December 28, 2009 to August 1, 2015, 27 implantations of BerlinHeart EXCOR® mechanical circulatory support system were performed in children aged from one month to 16 years (10 patients below one year of age; 37%). Left ventricular assist devices were implanted to 21 patients, whereas the remaining children received biventricular support. The most common reason for using this method was HF developed in the course of cardiomyopathy. In one case, HF after Fontan operation was the indication.
The duration of the circulatory support period ranged from six to 1215 days. It was followed by successful heart transplantations in 10 (37%) patients, in five (18.1%) it resulted in regeneration of the heart, enabling explantation of the device, whereas three children are still waiting for transplantations. Nine (33%) children died during the therapy because of thromboembolic complications.
As follows from our data, circulatory support utilising the BerlinHeart EXCOR® system is an effective and promising method used as a bridge to cardiac transplantation, or for regeneration of the myocardium in paediatric patients. In the group of the youngest and the most difficult patients, the method requires close cooperation of the medical and nursing personnel.
儿童和婴儿的晚期心力衰竭（HF）的治疗是一个严重的管理问题。该患者群体的心力衰竭通常是先天性的。儿科患者的治疗方案在大多数情况下是从成人治疗指南改编而来的。直到 2009 年，该极其困难的患者群体的治疗仅限于药物治疗和偶尔的心脏移植。由于招募供体的问题不断增加，特别是对于儿科群体，这导致机械支持使用心室辅助设备对于许多儿童来说是等待心脏供体期间存活的唯一机会。
本研究的目的是分析波兰循环支持的结果，并评估该方法治疗严重 HF 儿童的适宜性。
目前，波兰有三个中心使用这种治疗儿童患者的方法。自 2009 年 12 月 28 日至 2015 年 8 月 1 日，对 1 个月至 16 岁的儿童（10 例年龄在 1 岁以下，占 37%）进行了 27 例柏林心脏 EXCOR®机械循环支持系统的植入。左心室辅助装置植入 21 例，其余患儿接受双心室支持。使用该方法的最常见原因是在心肌病过程中发展为 HF。有一例是在法洛四联症术后出现 HF。
循环支持期的持续时间从 6 天到 1215 天不等。随后，10 例（37%）患者成功接受心脏移植，5 例（18.1%）患者心脏再生，成功取出装置，3 例患者仍在等待移植。9 例（33%）儿童在治疗过程中因血栓栓塞并发症死亡。
根据我们的数据，利用柏林心脏 EXCOR®系统的循环支持是一种有效的、有前途的方法，可作为心脏移植的桥梁，或用于儿科患者的心肌再生。在最年轻和最困难的患者群体中，该方法需要医疗和护理人员的密切合作。
