When No VAD is the Right VAD: Medical Management of Critically Ill Infants Awaiting Heart Transplantation
| Autor: | Yuk M. Law, Erik L Frandsen, Mariska Kemna, B. Hong, J.M. Friedland, Little, R. Mazor, Erin L. Albers, K.A. Banker |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Mechanical ventilation Heart transplantation Transplantation Pediatrics medicine.medical_specialty Ventricular function Heart disease business.industry Critically ill medicine.medical_treatment medicine.disease Circulatory system Cohort medicine Surgery Favorable outcome Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Heart and Lung Transplantation. 39:S451 |
| ISSN: | 1053-2498 |
| DOI: | 10.1016/j.healun.2020.01.277 |
| Popis: | Purpose Infants listed for heart transplant (HTx) are at high risk for waitlist (WL) mortality. While WL mortality for children has decreased overall in the current era of increased VAD use, outcomes for small infants supported by VAD remain suboptimal. We evaluated survival and morbidity in a cohort of critically ill infants listed for HTx and managed without VAD support. Methods Critically ill infants (defined as age Results Thirty-two critically ill infants were listed 1A for HTx during the study period, 66% with congenital heart disease. Mean age and weight at listing were 2.8 (±2) months and 4.4 (±1.3) kg, with the majority (69%) weighing 0.1). A favorable outcome was observed in 27 patients (84%) (26 HTx and 1 de-listed due to recovery of left ventricular function). Five patients (16%) died, including 3/5 patients supported with ECMO. Among patients who received a HTx, 24 (92%) survived to 1 year, with median post-HTx length of stay of 43 days. Two patients required tracheostomy post-HTx. Higher peak vasoactive-inotropic score (27 vs 16, p Conclusion A strategy incorporating a high threshold for mechanical circulatory support and acceptance of prolonged mechanical ventilation and neuromuscular blockade can achieve good short-term survival and morbidity outcomes for critically ill infants listed for HTx. |
| Databáze: | OpenAIRE |
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