Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, New York, New York.
Artif Organs. 2020 Jan;44(1):100-105. doi: 10.1111/aor.13558. Epub 2019 Oct 7.
Rejection with severe hemodynamic compromise is a significant source of morbidity and mortality for pediatric heart transplant patients. Traditionally, treatment for these patients includes inotropes and escalation to extracorporeal membrane oxygenation (ECMO) when necessary. There is increasing interest in using percutaneous ventricular assistive devices in the pediatric population as a less invasive alternative to ECMO. We report the largest case series to date of biventricular support using percutaneous Impella devices. Retrospective case series was performed by chart review. Hemodynamics, left ventricular ejection fraction (LVEF), and indices of end organ function were collected before and after Impella placement. A 14-year-old male, 18-year-old male, and 19-year-old female, all status post heart transplant, presented with severely decreased biventricular function due to presumed clinical rejection, requiring maximal inotropic support without improvement. In all the three cases, simultaneous Impella CP and RP devices were placed percutaneously. Prior to implantation, LVEFs were 40%, 23%, and 25%, respectively. Hemodynamics measured invasively prior to device placement showed elevated filling pressures. Adverse events while on support included bleeding, hemolysis, and right femoral arterial dissection during implantation. All patients were successfully weaned from the devices and survived to discharge. The average time of right-sided support and total support was 11 days and 13 days, respectively. After device removal, right-sided pressures and echocardiographic measurements showed improvement in all patients. Bilateral Impella configuration (BiPella) is a viable option for temporary mechanical circulatory support in pediatric patients with significant graft dysfunction.
严重血流动力学障碍导致的排斥反应是小儿心脏移植患者发病率和死亡率的重要原因。传统上，这些患者的治疗包括使用正性肌力药物，并在必要时升级为体外膜肺氧合（ECMO）。目前，人们越来越关注在儿科人群中使用经皮心室辅助装置作为 ECMO 的一种微创替代方法。我们报告了迄今为止最大的使用经皮 Impella 装置支持双心室的病例系列。通过病历回顾进行回顾性病例系列研究。收集 Impella 放置前后的血液动力学、左心室射血分数（LVEF）和终末器官功能指数。一名 14 岁男性、一名 18 岁男性和一名 19 岁女性，均在心脏移植后出现严重的双心室功能下降，由于疑似临床排斥反应，需要最大程度的正性肌力支持但没有改善。在所有这三个病例中，均经皮同时放置了 Impella CP 和 RP 装置。植入前，LVEF 分别为 40%、23%和 25%。植入前通过有创测量的血液动力学显示充盈压升高。支持期间的不良事件包括出血、溶血和植入过程中右侧股动脉夹层。所有患者均成功脱离设备并存活至出院。右侧支持和总支持的平均时间分别为 11 天和 13 天。设备移除后，所有患者的右侧压力和超声心动图测量均有所改善。在有明显移植物功能障碍的小儿患者中，双侧 Impella 配置（BiPella）是临时机械循环支持的可行选择。
