Monash University, School of Clinical Sciences, Clayton, Victoria, Australia; Murdoch Children's Research Institute, Hematology Research Group, Parkville, Victoria, Australia; Royal Children's Hospital, Department of Clinical Hematology, Parkville, Victoria, Australia.
Murdoch Children's Research Institute, Hematology Research Group, Parkville, Victoria, Australia; University of Melbourne, Department of Pediatrics, Parkville, Victoria, Australia.
Thromb Res. 2019 Jan;173:65-70. doi: 10.1016/j.thromres.2018.11.019. Epub 2018 Nov 22.
Durable Ventricular Assist Devices (VADs) are increasingly used in children with end-stage heart failure. Major complications are bleeding and thromboembolism (TE). Our objective was to determine the timing, incidence and risk factors for bleeding and TE in children implanted with VADs.
This was a retrospective cohort of 8 years experience for children implanted with HeartWare HVAD and Berlin Heart EXCOR VADs at the Royal Children's Hospital, Melbourne.
44 patients were implanted with Berlin Heart EXCOR or HeartWare HVAD devices. Major bleeding occurred in 17 patients (39%), 7 (16%) experienced thromboembolic strokes, 13 (30%) required device exchange for TE, and 4 (9%) experienced arterial thromboembolism. Twenty-seven patients (61%) were transplanted, three (7%) recovered, and six (14%) remain on device when censored. Eight patients (18%) died on VAD, with leading causes being thromboembolic stroke and intracranial bleeding. The majority of bleeding events and thromboembolic events occurred while patients were on unfractionated heparin (bleeding 66%, TE 40.5%) or transitioning between heparin and warfarin (bleeding 22%, TE 38%). Majority of patients were on more than one antiplatelet agent at the time of a major bleeding (87%) or thromboembolic (89%) event.
The majority of bleeding and TE events occurring in children supported with durable VADs occur when they are on unfractionated heparin or transitioning to warfarin. Modifications to anticoagulation and monitoring in the early post-operative periods should be a research focus.
耐用型心室辅助装置（VAD）在终末期心力衰竭的儿童中越来越多地使用。主要并发症为出血和血栓栓塞（TE）。我们的目的是确定植入 VAD 的儿童出血和 TE 的时间、发生率和危险因素。
这是一个在墨尔本皇家儿童医院植入 HeartWare HVAD 和 Berlin Heart EXCOR VAD 的 8 年经验的回顾性队列研究。
44 名患者植入了 Berlin Heart EXCOR 或 HeartWare HVAD 装置。17 名患者（39%）发生重大出血，7 名（16%）发生血栓栓塞性中风，13 名（30%）因 TE 需要更换装置，4 名（9%）发生动脉血栓栓塞。27 名患者（61%）接受了移植，3 名（7%）康复，6 名（14%）在截尾时仍在使用装置。8 名患者（18%）在 VAD 上死亡，主要原因是血栓栓塞性中风和颅内出血。大多数出血事件和血栓栓塞事件发生在患者使用未分级肝素（出血 66%，TE 40.5%）或肝素和华法林转换期间（出血 22%，TE 38%）。大多数患者在发生重大出血（87%）或血栓栓塞（89%）事件时同时使用不止一种抗血小板药物。
植入耐用型 VAD 的儿童中，大多数出血和 TE 事件发生在使用未分级肝素或转换为华法林时。早期术后抗凝和监测的改变应成为研究重点。
