Temporary ventricular assist device support with a catheter-based axial pump: Changing the paradigm at a pediatric heart center.

Autor:	Tume SC; Division of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex. Electronic address: sctume@texaschildrens.org., Fuentes-Baldemar AA; Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex., Anders M; Division of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex., Spinner JA; Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex., Tunuguntla H; Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex., Imamura M; Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex., Razavi A; Division of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex., Hickey E; Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex., Stapleton G; Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex., Qureshi AM; Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex., Adachi I; Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2023 Dec; Vol. 166 (6), pp. 1756-1763.e2. Date of Electronic Publication: 2022 Dec 24.
DOI:	10.1016/j.jtcvs.2022.11.039
Abstrakt:	Objective: We report the largest pediatric single-center experience with an Impella (Abiomed Inc) catheter-based axial pump support. Methods: We conducted a retrospective cohort study of all patients with acute decompensated heart failure or cardiogenic shock requiring catheter-based axial pump support between October 2014 and February 2022. The primary outcome per individual encounter (hospital admission) was defined as bridge-to-recovery, bridge-to-durable ventricular assist device support, bridge-to-cardiac transplantation, or death at 6 months after catheter-based axial pump explantation. Adverse events were defined according to the Pediatric Interagency Registry for Mechanical Circulatory Support criteria. Results: Our final study cohort included 37 encounters with 43 catheter-based axial pump implantations. A single catheter-based axial pump device was used for support in 33 encounters (89%), with 2 catheter-based axial pump devices used in 3 (8%) separate encounters and 3 catheter-based axial pump devices used in 1 (3%) encounter. The median [range] age, weight, and body surface area at implantation were 16.8 [6.9-42.8] years, 61.1 [23.1-123.8] kg, and 1.7 [0.8-2.5] m 2 , respectively. The predominant causes of circulatory failure were graft failure/rejection in 16 patients (43%), followed by cardiomyopathy in 7 patients (19%), arrhythmia refractory to medical therapies in 6 patients (16%), myocarditis/endocarditis in 4 patients (11%), and heart failure due to congenital heart disease in 4 patients (11%). Competing outcomes analysis showed a positive outcome with bridge-to-recovery in 58%, bridge-to-durable VAD support in 14%, and bridge-to-cardiac transplantation in 14% at 6 months. Fourteen percent of encounters resulted in death at 6 months. Conclusions: We demonstrate that catheter-based axial pump support in children results in excellent 1- and 6-month survival with an acceptable adverse event profile. (Copyright © 2022. Published by Elsevier Inc.)
Databáze:	MEDLINE
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