Evolution of Ventricular Assist Device Support Strategy in Children With Univentricular Physiology
| Autor: | Dilip S. Nath, Avihu Z. Gazit, Mark Shepard, Horacio G Carvajal, Brock K. Montgomery, Taylor C. Merritt, Matthew W. Canter, Mary Mehegan, Jacob R. Miller, Pirooz Eghtesady |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_treatment Physiology Aftercare Univentricular Heart law.invention law medicine Extracorporeal membrane oxygenation Cardiopulmonary bypass Humans Stage (cooking) Child Retrospective Studies Heart Failure business.industry Infant Newborn Infant Anticoagulants Device type Patient Discharge Neurologic injury medicine.anatomical_structure Treatment Outcome Ventricle Ventricular assist device Heart Transplantation Surgery Pulmonary Veno-Occlusive Disease Heart-Assist Devices Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of thoracic surgery. 114(5) |
| ISSN: | 1552-6259 |
| Popis: | Since 2012, we have supported 18 children with single ventricle (SV) physiology on ventricular assist devices (VADs) as a bridge to decision, transplantation, or recovery. We provide a detailed report of our cumulative surgical experience and lessons learned from these patients.We reviewed all SV-VADs between March 2012 and April 2020. Implanted SV-VADs intended for short-term support were excluded. Demographic and clinical data included palliation stage at the time of VAD implantation, cannulation configuration, device type, duration of support, circuit and device interventions, postoperative support, anticoagulation strategy, complications, mortality, and 1-year survival postdischarge.Five SV newborns without prior surgical palliation, 8 infants post-Norwood/hybrid procedure, 4 infants post-Glenn, and 1 infant post-Fontan were initially supported with either continuous-flow (n = 13 of 18, 72%) or pulsatile-flow (n = 5 of 18, 28%) devices. Three (17%) of 18 transitioned to another device during support. Before VAD conversion, 9 (50%) of 18 were supported by extracorporeal membrane oxygenation. Outcomes included 7 (39%) of 18 who transplanted, 2 (11%) of 18 who recovered, and 9 (50%) of 18 who died before discharge. Of these deaths, 2 occurred after transplantation and 2 after explantation, and 5 had redirection of care while on support secondary to previously undiagnosed pulmonary venoocclusive disease (n = 2) or severe neurologic events (n = 3). Overall, 6 (33%) of 18 experienced neurologic injury. At last follow-up, 9 (50%) of 18 children were alive (median 1.2 [interquartile range, 0.8-4.3] years postexplantation/transplantation).Our experience shows that SV children, including newborns, can be successfully bridged to desired endpoints with proper patient selection and using specific cannulation strategies. Continuing utilization of this strategy is warranted for future children requiring VAD support. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|