Elibol Pelin, Ulger Zulal, Engin Cagatay, Aydin Derya, Yilmaz Karapinar Deniz, Ersayoğlu İrem, Ozbaran Mustafa
Department of Pediatric Cardiology, Ege University, Izmir, Turkiye.
Department of Cardiovascular Surgery, Ege University, Izmir, Turkiye.
Acta Cardiol. 2024 Oct;79(8):869-877. doi: 10.1080/00015385.2024.2380843. Epub 2024 Aug 13.
This study aimed to evaluate thrombosis and bleeding events in the children implanted with two types of ventricular assist devices (VAD). A total of 26 paediatric end-stage heart failure patients with the mean age of 11.32 ± 4.17 years, 15 were boys, implanted with a VAD, either the Berlin Heart EXCOR (BHE group; = 9) or the HeartWare (HW group, = 17), were included in this retrospective study. Follow up data on bleeding events, thrombosis events, bridge-to-transplantation rates and survival outcome were recorded. Overall, 16(33.3%) bleeding events and 32(66.7%) thrombosis events occurred, while 14(53.8%) patients had at least one thrombotic event and 8(30.8%) patients had at least one bleeding event. BHE and HW groups were similar in terms of number of patients with at least one thrombotic (33.3% vs. 64.7%, = .218) or bleeding (22.2% vs.35.3%, = .399) event. Mortality occurred in 9(34.6%) patients and 13(50.0%) patients achieved bridge-to-transplantation, similarly in BHE and HW groups (mortality: 44.4% vs. 29.4%, = .667 and transplantation: 77.8% vs. 35.3%, = .097). In conclusion, our findings revealed that VAD application in children with heart failure enables successful heart transplantation achievement with an acceptable risk of bleeding/thromboembolic events in most of cases. More advanced VAD technologies and more successful management for haematologic complications are necessary to improve the transplantation rates in children.
本研究旨在评估植入两种类型心室辅助装置（VAD）的儿童的血栓形成和出血事件。共有26例平均年龄为11.32±4.17岁的小儿终末期心力衰竭患者，其中15例为男孩，植入了VAD，即柏林心脏EXCOR（BHE组；n = 9）或HeartWare（HW组，n = 17），纳入了这项回顾性研究。记录了出血事件、血栓形成事件、过渡到移植的比率和生存结局的随访数据。总体而言，发生了16例（33.3%）出血事件和32例（66.7%）血栓形成事件，而14例（53.8%）患者至少发生了一次血栓形成事件，8例（30.8%）患者至少发生了一次出血事件。BHE组和HW组在至少发生一次血栓形成（33.3%对64.7%，P = 0.218）或出血（22.2%对35.3%，P = 0.399）事件的患者数量方面相似。9例（34.6%）患者死亡，13例（50.0%）患者实现了过渡到移植，BHE组和HW组情况类似（死亡率：44.4%对29.4%，P = 0.667；移植率：77.8%对35.3%，P = 0.097）。总之，我们的研究结果显示，在心力衰竭儿童中应用VAD能够在大多数情况下以可接受的出血/血栓栓塞事件风险成功实现心脏移植。需要更先进的VAD技术和更成功的血液学并发症管理来提高儿童的移植率。
