Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Interact Cardiovasc Thorac Surg. 2022 Jun 15;35(1). doi: 10.1093/icvts/ivac051.
The aim of this study was to review a single institution's experience with EXCOR Paediatric implantation.
Patients <15 years old who underwent EXCOR implantation as a bridge to transplantation between 2015 and 2021 were enrolled. Major adverse events included death, cerebrovascular event resulting in sequelae, major infection (sepsis or surgical site infection requiring open sternal irrigation or device removal) and device malfunction requiring surgical treatment.
Overall median age and weight for all 20 children at implantation were 10.8 (interquartile range, 7.9-33.2) months and 6.3 (4.6-10.2) kg. Ten patients (50%) weighed <5 kg. Primary diagnoses were dilated cardiomyopathy in 13 patients, fulminant myocarditis in 3, restrictive cardiomyopathy in 2 and congenital heart disease in 2. Two patients required biventricular assist support. The median support time was 365 (241-636) days. Six patients (30%) were supported for >20 months. One patient died. Seven patients underwent heart transplant. Heart transplant has not been performed in the last 1.5 years. Five patients were weaned from EXCOR support after native myocardial recovery, including a patient with dilated cardiomyopathy who recovered after 24 months of EXCOR support. Major complication-free survival at 6, 12 and 18 months were 79.3%, 49.6% and 38.6%, respectively. Body weight <5 kg at implantation was a risk factor for decreased major complication-free survival.
Survival during EXCOR Paediatric support was good, but it prolonged the wait time for a heart transplant. The number of major complications increased over time and was not negligible, especially in small children.
本研究旨在回顾单中心使用 EXCOR 儿科体外生命支持系统的经验。
纳入 2015 年至 2021 年间接受 EXCOR 植入术作为心脏移植桥接的<15 岁患者。主要不良事件包括死亡、导致后遗症的脑血管事件、严重感染（败血症或需开胸冲洗或移除设备的手术部位感染）和需手术治疗的设备故障。
所有 20 名患儿植入时的总体中位年龄和体重分别为 10.8（四分位距，7.9-33.2）个月和 6.3（4.6-10.2）kg。10 名患儿（50%）体重<5kg。主要诊断为扩张型心肌病 13 例，暴发性心肌炎 3 例，限制型心肌病 2 例，先天性心脏病 2 例。2 例患儿需双心室辅助支持。中位支持时间为 365（241-636）天。6 名患儿（30%）支持>20 个月。1 例患儿死亡。7 例患儿行心脏移植。在过去的 1.5 年中，未进行心脏移植。5 例患者在心肌恢复后从 EXCOR 支持中脱机，包括 1 例扩张型心肌病患儿在 EXCOR 支持 24 个月后恢复。6、12 和 18 个月时无重大并发症生存率分别为 79.3%、49.6%和 38.6%。植入时体重<5kg 是无重大并发症生存率降低的危险因素。
EXCOR 儿科支持期间的生存率良好，但延长了心脏移植的等待时间。随着时间的推移，重大并发症的数量不断增加，不容忽视，尤其是在小患儿中。
