Shin Yu Rim, Park Young Hwan, Park Han Ki
Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Korean Circ J. 2019 Aug;49(8):678-690. doi: 10.4070/kcj.2019.0163. Epub 2019 Jul 3.
There have been great advances in ventricular assist device (VAD) treatment for pediatric patients with advanced heart failure. VAD support provides more time for the patient in the heart transplant waiting list. Augmented cardiac output improves heart failure symptoms, end-organ function, and general condition, and consequently provides beneficial effects on post-transplant outcomes. Miniaturized continuous flow devices are more widely adopted for pediatric patient with promising results. For infants and small children, still paracorporeal pulsatile device is the only option for long-term support. Younger age, congenital heart disease, biventricular support, patient's status and end-organ dysfunction at the time of implantation are risks for poor outcomes. Patient selection, timing of implantation, and selection of device for each patient are critical for optimal clinical outcomes.
对于患有晚期心力衰竭的儿科患者,心室辅助装置(VAD)治疗取得了巨大进展。VAD支持为患者在心脏移植等待名单上争取了更多时间。增加的心输出量可改善心力衰竭症状、终末器官功能和一般状况,从而对移植后结果产生有益影响。小型化连续流装置更广泛地应用于儿科患者,效果良好。对于婴儿和幼儿,体外搏动装置仍是长期支持的唯一选择。年龄较小、先天性心脏病、双心室支持、植入时患者状况和终末器官功能障碍是预后不良的风险因素。患者选择、植入时机以及为每位患者选择合适的装置对于实现最佳临床结果至关重要。