Mechanical circulatory support in children

Abstract

Nine children (aged 1.2-15 years) have been treated with mechanical circulatory support devices at our institution. Indications for treatment were acute cardiac allograft rejection (n = 4), postcardiotomy cardiogenic shock (n = 4), and bridge to cardiac transplantation (n = 1). Eight patients required left ventricular support, and one required biventricular support. A BioMedicus centrifugal pump was used in eight patients, and a Hemopump intra-aortic axial flow device was used in one patient. In two patients, an intra-aortic balloon pump was in place at the time that circulatory support was instituted. Mechanical support time ranged from 2 to 139 h, and the average flow index was 2.31 l/min per m2. Three patients required hemodialysis during support, and one patient required re-exploration because of mediastinal hemorrhage. Recovery of native ventricular function was assessed by transthoracic or transesophageal echocardiography, and weaning from the device was achieved by gradually decreasing pump flow in increments of 0.1 to 0.5 l/min. Seven patients were successfully weaned from support. Two hospital deaths occurred after circulatory support had been discontinued: one patient died of respiratory failure and the other of gram-negative pneumonia and sepsis. The five surviving patients experienced no significant complications, and their hemodynamic indices were normal at the time of discharge. At a mean follow-up of 28.8 months, these patients are leading active unrestricted lives, with no long-term device-related sequelae. Based on this experience, mechanical circulatory support is feasible in children who experience profound circulatory failure from a variety of causes.

Use of Mechanical Circulatory Support in Pediatric Patients With Acute Cardiac Graft Rejection

“…We were unable to find a manuscript on pediatric VAD support for acute heart rejection from another institution. 24 However, we speculate that other pediatric programs have been applying VADs for this indication. The adult literature on this subject is discouraging, with weaning rates from MCS for AR of 15%-20%.…”

“…10 -16 The use of MCS to treat cardiac failure caused by acute graft rejection has been reported in small series in adults but not in the pediatric population except from an earlier report from this institution. [17][18][19][20][21][22][23][24] When patients with graft rejection and hemodynamic instability are mechanically supported, the circulation is secured, allowing for aggressive immunosuppressive strategies. 25 This manuscript reports the use of MCS at Texas Children's Hospital in patients with severe acute cardiac allograft rejection causing hemodynamic instability.…”

Survival after acute graft failure in pediatric thoracic organ transplant recipients

“…Experience with mechanical circulatory support in pediatric patients awaiting primary or repeat thoracic organ transplant has been reported from several centers ( 11–18). Extracorporeal membrane oxygenation is the modality most commonly utilized as opposed to centrifugal pumps or pneumatic ventricular assist devices ( 19).…”

Mechanical circulation support of the treatment for children with end-stage chronic heart failure

“…С разработкой в начале 1900-х годов центробеж-ных насосов (ЦН) Bio-Рump (MedtronicBio-Medicus, Minneapolis, MN), значительно меньше травмирую-щих кровь по сравнению с роликовыми насосами, появилась возможность относительно длительного ОЛЖ при постоперационных осложнениях и ис-пользования этого насоса в качестве моста для ТС у взрослых и педиатрических пациентов, находящих-ся в критическом состоянии [32,33].…”