Department of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee, USA.
Department of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatr Transplant. 2022 Dec;26(8):e14391. doi: 10.1111/petr.14391.
The use of mechanical circulatory support (MCS) for pediatric patients who have undergone heart transplant has grown rapidly in the past decade. This includes support in the immediate post-transplant period and "rescue" therapy for patient later in their transplant course. Extracorporeal membrane oxygenation (ECMO) remains a standard modality of support for intraoperative concerns and for acute decompensation in the immediate post-transplant period. However, both pulsatile and continuous flow ventricular assist devices (VADs) have been used with increasing success in transplant patients for longer durations of support. Centers participating in the Pediatric Heart Transplant Society (PHTS) were queried to provide their internal protocols and rationale for mechanical circulatory support following heart transplant. These protocols coupled with evidence-based literature were used to provide the following description of clinical approaches to MCS in the transplant patient highlighting areas of both broad consensus and significant practice variation.
在过去十年中，接受心脏移植的儿科患者使用机械循环支持（MCS）的情况迅速增加。这包括在移植后即刻的支持和“抢救”治疗，以挽救移植后期的患者。体外膜氧合（ECMO）仍然是支持术中问题和移植后即刻急性失代偿的标准模式。然而，搏动性和连续性血流心室辅助装置（VAD）在移植患者中已经越来越成功地用于更长时间的支持。参与小儿心脏移植协会（PHTS）的中心被要求提供其内部协议和在心脏移植后使用机械循环支持的基本原理。这些协议结合循证文献，用于提供移植患者机械循环支持的临床方法描述，突出了广泛共识和显著实践差异的领域。
