Maeda Katsuhide, Rosenthal David N, Reinhartz Olaf
Departments of Cardiothoracic Surgery, Stanford University, Stanford, California.
Pediatric Cardiology, Stanford University, Stanford, California.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2018 Mar;21:9-14. doi: 10.1053/j.pcsu.2017.11.005.
Heart transplant waitlist survival in pediatric patients has been substantially improved since the introduction of pediatric-specific ventricular assist device. In neonates and infants, however, the waitlist mortality remains very high. The only long-term device currently approved for use in the United States is the Berlin Heart EXCOR, but this device has several important limitations because of the paracorporeal, pulsatile nature of the underlying technology. We reviewed Stanford ventricular assist experience on patients less than 1 year old since 2004. It shows overall 1-, 3-, and 5-year survival were 68%, 62%, and 49%, respectively. There are statistically significant differences in survival among cardiomyopathy group, end-stage congenital heart disease group and single ventricle group. In order to improve outcomes in this extremely high risk group, modifications were made to anticoagulation protocols, cannulation strategy in hypertrophic cardiomyopathy patients, and preferential use of continuous flow pumps in a single ventricle patients. The long-waited PumpKIN trial testing the Jarvik 2015 is about to start with the first human implant.
自引入儿科专用心室辅助装置以来，儿科患者心脏移植等待名单上的生存率有了显著提高。然而，在新生儿和婴儿中，等待名单上的死亡率仍然非常高。目前在美国唯一获批长期使用的装置是柏林心脏EXCOR，但由于其体外搏动性的基础技术，该装置有几个重要局限性。我们回顾了自2004年以来斯坦福大学对1岁以下患者的心室辅助经验。结果显示，总体1年、3年和5年生存率分别为68%、62%和49%。心肌病组、终末期先天性心脏病组和单心室组之间的生存率存在统计学显著差异。为了改善这个极高风险组别的治疗效果，对抗凝方案、肥厚型心肌病患者的插管策略以及单心室患者优先使用连续流泵进行了改进。期待已久的测试Jarvik 2015的PumpKIN试验即将开始首例人体植入。
