Single Ventricular Assist Device Care and Outcomes for Failed Stage I Palliation: A Single-Center Decade of Experience.

Autor:	Kulp BE; From the Washington University School of Medicine in St Louis Department of Pediatrics and St Louis Children's Hospital, St Louis, MO., Khan MN; From the Washington University School of Medicine in St Louis Department of Pediatrics and St Louis Children's Hospital, St Louis, MO.; Division of Pediatric Critical Care Medicine, St Louis, MO., Gazit AZ; From the Washington University School of Medicine in St Louis Department of Pediatrics and St Louis Children's Hospital, St Louis, MO.; Division of Pediatric Critical Care Medicine, St Louis, MO.; Division of Pediatric Cardiology, St Louis, MO., Eghtesady P; From the Washington University School of Medicine in St Louis Department of Pediatrics and St Louis Children's Hospital, St Louis, MO.; Division of Cardiothoracic Surgery, St Louis, MO., Scheel JN; From the Washington University School of Medicine in St Louis Department of Pediatrics and St Louis Children's Hospital, St Louis, MO.; Division of Pediatric Cardiology, St Louis, MO., Said AS; From the Washington University School of Medicine in St Louis Department of Pediatrics and St Louis Children's Hospital, St Louis, MO.; Division of Pediatric Critical Care Medicine, St Louis, MO., Rabinowitz EJ; From the Washington University School of Medicine in St Louis Department of Pediatrics and St Louis Children's Hospital, St Louis, MO.; Division of Pediatric Critical Care Medicine, St Louis, MO.; Division of Pediatric Cardiology, St Louis, MO.
Jazyk:	angličtina
Zdroj:	ASAIO journal (American Society for Artificial Internal Organs : 1992) [ASAIO J] 2024 Jun 01; Vol. 70 (6), pp. 517-526. Date of Electronic Publication: 2024 Feb 12.
DOI:	10.1097/MAT.0000000000002149
Abstrakt:	Single ventricular assist device (SVAD) use before and after stage I palliation (S1P) is increasing with limited data on outcomes. To address this knowledge gap, we conducted a single-center retrospective review to assess pre- and post-SVAD clinical status, complications, and outcomes. We leveraged a granular, longitudinal, local database that captures end-organ support, procedural interventions, hematologic events, laboratory data, and antithrombotic strategy. We identified 25 patients between 2013 and 2023 implanted at median age of 53 days (interquartile range [IQR] = 16-130); 80% had systemic right ventricles and underwent S1P. Median SVAD days were 54 (IQR = 29-86), and 40% were implanted directly from ECMO. Compared to preimplant, there was a significant reduction in inotrope use ( p = 0.013) and improved weight gain ( p = 0.008) post-SVAD. Complications were frequent including bleeding (80%), stroke (40%), acute kidney injury (AKI) (40%), infection (36%), and unanticipated catheterization (56%). Patients with in-hospital mortality had significantly more bleeding complications ( p = 0.02) and were more likely to have had Blalock-Thomas-Taussig shunts pre-SVAD ( p = 0.028). Survival to 1 year postexplant was 40% and included three recovered and explanted patients. At 1 year posttransplant, all survivors have technology dependence or neurologic injury. This study highlights the clinical outcomes and ongoing support required for successful SVAD use in failed single-ventricle physiology before or after S1P. (Copyright © ASAIO 2024.)
Databáze:	MEDLINE
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