From the Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
ASAIO J. 2022 Apr 1;68(4):577-583. doi: 10.1097/MAT.0000000000001635.
Pediatric mechanical circulatory support (MCS) has been successfully used to bridge numerous children to transplantation who otherwise would have been unlikely to survive on the waitlist and, in many cases, make them better transplant candidates. The purpose of this study was to analyze what the pediatric heart failure community has achieved over the last 15 years in reaching 1,200 cases of bridging children to heart transplantation. The United Network for Organ Sharing database was used to identify MCS patients ages 0-18 at the time of listing for heart transplantation between 2005 and 2019, divided into three eras: first (2005-2009), second (2010-2014), and third (2015-2019). From 2005 to 2019, 1,289 pediatric cases were identified. More patients were successfully bridged to transplantation with MCS in the third-era (28%) [vs. first-era (16%), second-era (24%), p ≤ 0.004]. The proportion of discharges on ventricular assist device has increased as well from 3% to 22% (p < 0.001). Post-transplant survival was significantly better in the third era (1-year survival: 96%; 3-year survival: 89%) compared to the two previous eras (p = 0.006). On MCS, renal dysfunction, ventilator dependence, inotrope use, and functional status improved from the time of listing to transplantation (p < 0.01). Hepatic dysfunction (p < 0.001), renal dysfunction (p = 0.004), congenital heart disease (p = 0.023), and infant age (p = 0.002) were risk factors for post-transplant mortality. Over the last 15 years, pediatric MCS has become an accepted and increasingly used strategy for bridging children to transplantation. MCS therapy is associated with improved end-organ function at the time of transplantation, perhaps contributing to the increasing post-transplantation survival of patients bridged with MCS.
儿科机械循环支持（MCS）已成功用于桥接许多儿童进行心脏移植，否则他们在等待名单上可能无法存活，而且在许多情况下，使他们成为更好的移植候选者。本研究的目的是分析儿科心力衰竭界在过去 15 年中取得了什么成就，使 1200 例儿童成功桥接到心脏移植。使用美国器官共享网络数据库来确定 2005 年至 2019 年期间接受心脏移植时年龄在 0-18 岁的 MCS 患者，并将其分为三个时期：第一期（2005-2009 年）、第二期（2010-2014 年）和第三期（2015-2019 年）。从 2005 年到 2019 年，共确定了 1289 例儿科病例。在第三期，有更多的患者通过 MCS 成功桥接到移植（28%）[与第一期（16%）和第二期（24%）相比，p≤0.004]。心室辅助设备出院的比例也从 3%增加到 22%（p<0.001）。与前两个时期相比，第三期的移植后生存率显著提高（1 年生存率：96%；3 年生存率：89%）（p=0.006）。在 MCS 上，肾功能障碍、呼吸机依赖、儿茶酚胺使用和功能状态从上市到移植都有所改善（p<0.01）。肝功能障碍（p<0.001）、肾功能障碍（p=0.004）、先天性心脏病（p=0.023）和婴儿年龄（p=0.002）是移植后死亡的危险因素。在过去的 15 年中，儿科 MCS 已成为桥接儿童进行移植的一种被接受且越来越常用的策略。MCS 治疗与移植时终末器官功能的改善相关，这可能有助于 MCS 桥接患者的移植后生存率提高。
